386 he adds, "This heir, by the Greek writers, is called aтonλngovóμos, and St. Paul is thought to allude here, when he writes ὥστε οὐκ ἔτι εἰ δῆλος, ἀλλ' υἱὸς εἰ δὲ υἱος, καὶ κληςόνομος. Ερ. ad Galat, cap. 4, verse 7.

With thefe inconfiderable deductions from its general merit, we hesitate not to pronounce the tranflation of A. Gellius a most valuable acceffion to English literature. Certain we are, it must have coft the author infinite labour; but we trust the merited praise attending it will enable him to acquiefce in the following obfervations of a brother critic of antient days.

Εἰ δέ τῳ δοκεῖ καὶ πόνε πολλά ταύλα καὶ πραγματείας μεγάλης ἄξια εἶναι, καὶ μάλα ορθώς δοκεί κατὰ τὸν Δημοσθένην· ἀλλ ̓ ἐὰν λογίσηται τὰς ἐξακολυθενιας ἂν τοῖς κατορθωμένοις ἐπαίνες, καὶ τὸν καρπὸν τῶν ἁπάντων, ὡς γλυκὺς, ευπα θέιας ἡγήσεται τὰς πόνος

ART. VII. The Hiftory of two Cafes of ulcerated Cancer of the Mamma; one of which has been cured, the other much relieved, by a new Method of applying Carbonic-Acid Air: illustrated by a Copper-plate; with Obfervations. By John Ewart, M. D. one of the Phyficians of the Bath City Infirmary and Difpenfary. 8vo. pp. 62. Is. 6d. Crutwell, Bath; Dilly, London. 1794.

THE first application of fixed, or, as it is now more proper

ly termed, Carbonic-Acid Air, to cancerous ulcers, appears to have been made in the beginning of 1772, by that able furgeon Mr. White of Manchefter; who was probably led by the remarkable fweetening property, which Dr. Priestley and others had just then difcovered it to poffefs, over putrid animal matter, to try its effects in correcting the foetor of these fores. The only account of this attempt, which we have feen, is given very briefly by Dr. Percival in his paper on the Medicinal Ufes of Fixed Air, (Essays Med. & Experim. v. 2.) in which he says, that the fixed air fweetened the discharge, mitigated the pain, and produced a better digeftion; but adds, that after two months affiduous application, no farther progrefs was made towards a cure. M. Peyrillie, in his Differtatio de Cancro, which gained a double prize from the Academy of Sciences at Lyons in the year 1773, after endeavouring to prove, that the cancerous virus arofe from a putrid fermentation of stag

* Dion Halicarn. Σύνθεση Set. 24ο

περι U u 2

nant

nant lymph in the diseased part, proposed the gas fylveftre, or fixed air, as a corrector for it; and relates two cases of can cer, one of the lip, the other of the breaft, where this application was attended with fuch favourable effects, that there was great reason to expect a cure would have been attained, had not both patients been carried off in the mean time, by other diseases. A few other inftances, perhaps, might be collected by a diligent fearch through later medical writings, where fixed air had been tried with relief in cancer; but none has occurred to us worthy of notice except the following, which is mentioned only tranfiently by the late Dr. White of York, in his treatife on Phthifis Pulmonalis, p. 187. "The offenfive

smell attending an ulcerated cancer, is far from being the leaft part of a patient's fufferings; this is effectually taken off by the application of fixed air, which alfo very powerfully alters the malignancy of the ulcer, as I have feveral times experienced. I fav an ulcerated cancer of the breast, so large as to be able to contain a large pine-apple, reduced to the fize of a crown piece by the application of fixed air: it was indeed affifted by the Cicuta."

Such, we believe, was the amount of the public teftimonies in favour of this remedy in cancer, until the appearance of Dr. Ewart's pamphlet, which has certainly excited, and indeed appears to deserve, a greater fhare of attention, than any thing that has yet been offered on the fubject.

The firft cafe is that of Sufan Alford, aged 58; admitted, on the 24th of June, 1794, an out-patient of the Bath City Infirmary and Difpenfary, for an ulcer on the upper part of the left breaft, extending nearly five inches in length, between three and four in breadth, and about two in depth; with a finus running from the lower part downwards under the skin, of fuch a depth and capacity, that the used several times a day to prefs out from it the quantity of one, two, or more table spoonfuls of an intolerably foetid matter. The furface of the ulcer was of a thining gloffy hue, without any appearance of granulations. The ragged margins of the fore, and the fubftance of the mamma (which was naturally of a large fize) to the distance of an inch or two round, but chiefly below it, were fwelled and indurated, forming irregular knobs, which in many places feemed to adhere to the pectoral muscle beneath. The whole was attended with a'molt constant pricking pain, which The fom times compared to a fenfation of burning, and this frequently increafed to fuch an extreme degree of agony, as to make her fcream out for hours together. Some ounces of blood were often difcharged from the fore, which happened most generally when the was warm in bed, and was followed

by

by a temporary abatement of the pain. Her appetite and ftrength were much impaired; her body had been progreffively emaciating, and her fpirits were funk with long fuffering, and the defpair, of finding relief. She complained of attacks of fhivering, fucceeded by heat and thirst, and afterwards by cold fweats, which particularly occurred in the night.

The complaint originated from a blow received on the breaft, fourteen years before; and from the hiftory of its progrefs, minutely detailed by Dr. E. as well as from the concurring opinions of feveral eminent practitioners at Bath, little room, he obferves, is left to doubt the cancerous nature of the disease, One circumstance only strikes us as unufual, namely, that "the axillary glands do not appear to have been at any time affected."

Dr. E. obferves, that on his firft feeing the patient, he entertained no greater hopes of affording her any effential benefit, than the other gentlemen had done, whom the confulted before him; yet the imperfect attempts to apply the Carbonic-Acid Air, which he had seen or heard of, though not fuccessful enough to have generally encouraged its further trial, had nevertheless afforded fuch a degree of relief, as to promife ftill greater advantage from a better application of the remedy. The following mode was accordingly determined on The neck of a bladder was cut off, fo as to make an opening large enough to cover the ulcer entirely, and the cut edge faftened in fuch a manner as to be air tight, to a circular aperture of correfponding fize, made in a piece of foft leather covered with plaifter: the bladder and leather thus joined, fomewhat refembling a hat with a high crown and narrow brim. The leather being then clofely applied, by means of the plafter spread upon it, to the found tkin round the ulcer, the bladder, previously compreffed to expel the atmospheric air, was inflated with Carbonic-Acid Gas, through a fmaller orifice made at the fundus, into which the gas was conveyed by a flexible tube, communicating with an apparatus that held an effervefcing mixture of chalk and vitriolic acid: as foon as the bladder was full, the orifice at the fundus was tied up, fo as to detain the gas, and keep it in contact with the furface of the ulcer; and a small cradle, made of wire, was placed over the bladder, to prevent it from being preffed on. The air was renewed twice, fometimes three times, a day, accordingly as its efcape or abforption ren-. dered a fupply neceflary; but fo well did the contrivance anfwer its purpose, that when the bladder was filled at night, it was generally found to contain a confiderable quantity of its air in the morning.

At

At each application of the air, the first fenfation was that of coldness, lafting for a few minutes, and fucceeded by a glowing warmth, which continued for half an hour. She declared, on the fift morning after it was applied, that the felt eafier, and her rapturous expreffions of relief were rendered unequivocal in a few days, by an evident and confiderable amendment in the appearance of the fore. The procefs of healing went on without any interruption, except once that the difcharge became fomewhat bloody, from her having hurt the breast by turning on her face while asleep, and another time that an eryfipelatous eruption appeared on it, accompanied with fever and fore throat, which feemed entirely adventitious. By the 19th of September, the fore was filled up and fkinned over; neither the original fubftance of the breaft, nor the new formed part, had any perceptible induration; and the whole bore handling and prelure without the leaft uneafinefs: the fkin, however, which covered the cicatrix, was fill irregularly elevated and hardened. On the 30th of September, juft fourteen weeks from her admiffion, the was difcharged cured; having completely recovered her appetite, her ftrength, and her fleep, and being in every refpect a renovated creature.

It is proper to obferve, that at the fame time the CarbonicAcid Air was prefcribed, the patient was ordered to take the fixteenth part of a grain of arfenic, in folution, three times a day; and continued to do fo from about a week after her admiffion, until within a fortnight of her being difcharged. But Dr. E. remarks, that the benefit of the C. A. Air was evident before the arfenic was administered, and that the continuance of this remedy was owing to his abfence from Bath during that period, and to the apothecary's attention, that the whole of the original prefcription fhould be ftrictly exccuted. We could have wifhed, however, that the Carbonic-Acid Air alone had been en ployed; as the exhibition of a medicine which M. Febure and others have afferted to be frequently fuccefsful in the cure of cancer, neceffarily creates a doubt whether the gas by itself would have answered; more efpecially as it did not prove equally efficacious in the fecond cafe, in which arfenic was not given.

The fecond cafe is, that of Mrs. A. aged 57, wife of a banker at Bath. Here the complaint originated without any obvious caufe, about three years before; and, from the time that the tumor had been converted into an ulcer, by the repeated and injudicious application of cauftic, under the direction of a quack, excepting a temporary amendment, which occurred on her first taking the Barytes Muriata internally, and using

an

an external application that fhe received from Ireland*, the ravages of the difeafe, both on the part, and on the conftitution, had been rapid and uninterrupted. When Dr. E. firft faw her, a hideous ragged fore, extending fix inches in length, nearly five in breadth, and two in depth, occupied the left breaft; having in the center a hard ulcerated tumour, which poured out blood upon the leaft preffure being applied to it, and from which, a few days before, not lefs than a pint of blood had iffued at one evacuation. The difcharge was copious, thin, ichorous, and highly offenfive. The pain extreme, and almoft without ceafing; fo that the had not enjoyed one night of repofe for twelve months. Her body emaciated nearly to a skeleton, her appetite gone; and pulfe from 100. to 120; with chilly fits, fucceeded by heat and fweating, particularly in the night.

On the 28th of July 1794, the Carbonic-Acid Air was applied as already defcribed, and on the 30th the declared her breaft quite cafy, refted better than for fome months, and next day could move the left arm with more freedom, The ulcer foon became free from bad fmell, and the difcharge puriform, but ftill very copious. Her debility and want of appetite, however, growing alarming, a general restorative plan was injoined, and fhe was ordered to take, three or four times a day, an ounce and a half of a pretty ftrong decoction of the broadleaved willow bark, which, Dr. E. fays, he has found little, if at all, inferior to the Peruvian bark, as a tonic medicine, and grateful to many flomachs which rejected the latter. A smart attack of fever fupervening, (apparently from expofure to cold) this was changed for faline and antimonial medicines, and thefe again, when the fever fubfided, for Dr. Griffith's mixture, containing myrrh, kali, and vitriolated iron, which was continued afterwards. The progrefs towards a cure, however, was by no means fo rapid or so steady here as in Alford's cafe; for, although at the end of two months Mrs. A. was free from pain, flept well, had recovered her appetite, and, in a great degree, her ftrength, yet the fore had contracted only an inch in one direction, and half an inch in the other; and, in a note, added we prefume about the time of publication, (Oct. 9th,) we are told, that on the 3d and 4th of October the had fome return of pain, and of ichorous discharge, which however was

This we take to be what is known by the name of Plunket's remedy, which is compofed of the ranunculus hammula, two handfuls; cotula fœtida, one handful; white arfenic, 3ij; flowers of fulphur, 3j; reduced to a powder, and this made into pafte with white of egg.

attributed