The term escharotic (Gk: ἐδχάρα, scab) entered the English lexicon in 1655 and is defined as any process reducing abnormal tissues to a "brown or black dry slough" ("escharotic," OED. I, 893). In the nineteenth century, the escharotic treatment of cancer, involving the application of caustic agents, became an alternative to the use of heated irons and was recognized, in some cases, to be a complement to conventional surgery (Munro 274-75; Stone 628-630).
Chemical Surgery & Professional Rivalry
Escharotic practitioners were often at odds with traditional surgeons who scoffed at their remedies. Dr. Samuel Young, in his 1805 Inquiry into the Nature and Action of Cancer, described a dispute between Drs. Richard Guy and Thomas Gataker (Surgeon Extraordinary to the King) over the efficacy of the controversial escharotic mixture, Plunkett's remedy. Beginning in 1754, Dr. Guy routinely prescribed, and defended the use of, Plunkett's topical anticancer formula (arsenious acid, sulfur, and powdered flowers), whereas Dr. Gataker, a traditional surgeon, denounced it as a quack medicine (The Answer of Richard Guy [Review], 239; Young 82-6; Dunglison 765). Young who sided with Dr. Guy thought the prevailing, negative consensus had been bolstered by the opinions of skeptics who, having misapplied escharotics, assumed negative outcomes proof of their worthlessness (86-7). Because the surgical community was, for the most part, opposed to caustics, no serious inquiry into their value had ever been conducted; obstructionism led to the default of this branch of medicine to heterodox physicians (both ethical and unethical) and to unqualified operators:
This negligence on the part of science has given proportionate scope to the invention of the quacks;--they seized upon the arms the regulars threw away, and have certainly played no unsuccessful part. Even old women, enlisted under the banners that were deserted, have proved at least (as far as their knowledge of the question went) that there is just as much orthodoxy in a piece of caustic as in a piece of [red-hot] iron! (Young 83).
Young was understandably dismayed that, to the detriment of suffering patients, the capabilities of escharotic medicine as an alternative or adjuvant to traditional cancer treatment were being ignored. The discovery and medical applications of zinc chloride, from 1812 to the late 1830s, catalyzed interest in the potential of escharotic therapy. In the 1870s, Middlesex Hospital (London) experiments epitomized this trend through a combined ablation-cauterization technique for skin and breast cancers.
A Period of Classification
Despite the obstructionism, from 1822 to 1889 the pharmacological literature gradually made clear that a wide variety of escharotic agents were available and classifiable according to chemical composition, structure, and properties. Nathaniel Chapman, in the 1822 edition of Elements of Therapeutics and Materia Medica, defined escharotics as substances that "erode or dissolve" animal tissues; and he differentiated between two subsets: the actual form, employing fire or heated iron; and the potential form, employing chemicals (131). Of the twelve caustics Chapman listed, five were designated as the most powerful: potash, a vegetable alkaloid for ulcers; silver nitrate, a metallic coagulant for ulcers (132); white oxide of arsenic (135); mercurial preparations, notably corrosive sublimate (mercury chloride: HgCl2) (Chapman 137; Wigglesworth 49-51); and, lastly, tar unguents, for tinea infections (Chapman 138; "Unguentum Picis Liquidӕ").
In 1852, the chemist Dr. Jonathan Pereira (1804-1853), in Elements of Materia Medica, taxonomized three Orders of topical medicine: I. Caustics; II. Astringents; III. Disinfectants (199). A Suborder to I.-Caustics comprised Escharotica, substances that destroyed the part to which they were applied, and which produced sloughs that separated from the healthy tissue. Pereira listed five of the most effective members of the Suborder: sulfuric acid, nitric acid, potash, antimony trichloride (a gray metalloid element: SbCl3), and zinc chloride (ZnCl2) (199-200).
The Scottish obstetrician, James Young Simpson (1811-1870), in the 1857 article, "Suggestion of a New Caustic in the Treatment of Local Cancerous and Cancroid Diseases, Etc.," also classified the family of caustic substances. Unlike Pereira, Simpson constructed a tripartite scheme based exclusively on chemical classification: I. Concentrated alkalis; II. Concentrated acids; and III. Metallic preparations. The Metallic salts, with which he was primarily concerned, included compounds of arsenic, antimony, mercury, platinum, gold, zinc, copper, and others metals; arsenic and zinc chloride were deemed most valuable (55-56). Simpson sought to publicize the effectiveness of zinc sulfate (ZnSO4), the third compound in the Metallic class. Dispensed as powder, paste, or ointment, its activity and manageability (in Dr. Simpson's judgment) were superior to other substances; also recommending it were its easy preparation, thick consistency, and exceptional activity as a cancer agent (57).
Escharotic medicine, in this period, became standardized through clinical articles, historical surveys, and pharmacological compendia. One surveyor was Dr. Samuel Langston Parker (1803-1871), a dermatological surgeon at Queen's and at Leamington Hospitals. His 1856 survey (republished in 1867) was an index to the increasing acceptance of escharotic medicine in the mid-Victorian period, and to its value as an alternative to conventional surgery. Dr. Parker impartially observed that cauterization was sometimes indicated when ablation was either intolerable or clinically inadvisable; but, on the question of recurrence, he conceded that the evidence gave a slight advantage to dissection over cauterization (3). Even though escharotic information regularly occurred in standard texts, Parker believed that, nationally, research and development was still lagging: escharotic therapy was "a subject to which little attention has been paid in Great Britain, at least systematically, although there are many isolated cases recorded . . . which point to this mode of treatment (under certain circumstances) as valuable, effective, and safe" (2). The situation was much different on the continent, as the practice was “fast gaining ground" (2). Many systematic works had appeared in Europe, and, in some French hospitals, surgeons routinely used these substances and delivered clinical lectures on this branch of surgery (2). One noteworthy series, delivered in Paris, from 1852 to 1854, was Dr. Jules Germain François Maisonneuve's (1809-1897), "Leçons Cliniques sur les Affections Cancéreuses, professées à l'Hôpital Cochin" (2).
Parker also pointed to circumstances, such as localized disease, under which an escharotic rather than ablation was the correct choice (10). If a caustic was indicated, Parker selected arsenical and zinc chloride pastes (22), the concentrated mineral acids (19), nitric and sulfuric acids (19), alkaline caustics, notably potassium plus lime (as a solid, known as caustic Filhos) (20-21), and chloride of bromine (which Dr. Landolfi had popularized) (Parker 10-11, 22-6; Biddle 370; Lasègue 200-01). He rightly credited Drs. Canquoin and Fell for having devised effective ways of administering caustics, and as having obtained "many sound and good cures" in cases where primary ablation had failed or could not be employed (11). Parker also praised "a compound procedure" that Drs. Campbell Grieg De Morgan (1811-1876) and Charles Hewitt Moore (1821-1870) had designed, which was an extrapolation from the 1857 J. Weldon Fell trial at Middlesex Hospital, using S. canadensis and zinc chloride. De Morgan, Moore, and colleagues, in 1866, initially excised tumors surgically and then administered graduated strengths of the zinc-chloride lotion (20, 30, or 40 grains of the salt per ounce of water). The lotion was intended to destroy microscopic cancer cells, post-surgically, that might have "disseminated through the wound, or the neighboring tissues" (11).
Dr. Parker considered how, in specific instances, caustics were superior to the knife. To avoid disfigurement, for example, they should be used on ulcerated cancers of the skin, lips, tongue, and uterus, especially "where the patient appears sinking from local symptoms of the disease, such as frequent hemorrhages, profuse and fetid discharges, where also a great extent of surface is destroyed" (27, 34-41). As Dr. Maisonneuve had recounted from his clinical experiences, the use of escharotics for these conditions often produced healthy granulating tissues (28-29). When the disease recurred after ablation, a patient averse to secondary surgery would often choose the chemical alternative.(29).
Echoing Dr. Young's 1805 sentiment, Parker reaffirmed that the action of the paste should not be underestimated. Dr. Alfred Velpeau (1795-1867) had recently made dramatic claims in favor of escharotic therapy, one of which was that he had destroyed invasive tumors of the breast and axilla (Parker 30-31). Parker asserted that caustics, such as citric, acetic, and carbolic acids, along with zinc chloride, had an inherent advantage over ablation and that the combination of a powerful caustic, to destroy the primary tumor, and of a lotion, to kill surviving cancer cells, was likely to yield good results. His enthusiasm was justified by the exciting progress of De Morgan and Moore. The combined therapy, it should be noted, was a sequent to the 1857 ZnCl2 Fell's trial at Middlesex Hospital (33, 41).
Intelligent Use
In 1889, the Boston surgeon, John Cummings Munro (1858-1910), in the survey, "Escharotics in the Treatment of Disease," concluded that ablation was superior to chemical surgery; but, like Drs. Simpson and Parker, he recognized that, "there are a small number of cases where the use of the knife is impracticable or impossible; in these, caustics, if any treatment is possible, can and ought to be used" (272). This idea was consonant with one that Dr. Thomas Spencer Wells, a vehement critic of "irregular" practice, had expressed in 1857. Dr. Munro arrived at a reasonable conclusion about chemical surgery: “An intelligent, skillful use of escharotics . . . is capable of doing a great deal of good in cases not suitable for excision." "Intelligent use," he continues, will the reputation of this branch of surgery which profiteering researchers, like Dr. Jesse Weldon Fell, or charlatans, like M. Vries, "The Black Doctor of Java," had severely damaged (Munro 275; "The Black Doctor [of Java]").
Henry Trentham Butlin (1845-1912), renowned head-and-neck surgeon to whose work Munro referred, also understood the need to employ escharotics judiciously, as well as in conjunction with conventional surgery, in the treatment of breast cancer ("Two Cases," 61-4). Dr. Butlin went further than Munro, urging that caustics be used more frequently, even though it was not known as to whether they improved recurrence rates. Neither surgeon denied the fact that, over the past several decades, the knife and the caustic had had discouraging results. Munro had little doubt, however, that caustics were safer than the knife. Dr. Butlin theorized as to why caustics had been unjustly undervalued: quacks had misused them and exploited patients, while legitimate practitioners, not in the habit of using them, were as ignorant of their limitations and potentials as those who employed them unethically. Because cancer surgery generally had poor results, due to pain, disfigurement, infection, and inevitable recurrences, patients understandably dreaded it and were left with no other recourse than to consult heterodox healers. Ironically, in many cases, the treatment received from established physicians was equivalent to that received from "irregulars." Quackery, Dr. Butlin reflected, could not be eliminated by ridiculing irregular formulae and methods or by ignoring their genuine successes. Recalling the 1805 sentiment of Dr. Young, he professed the need for a rational strategy and for open-mindedness: the medical community should study all methods and to subject them to rigorous testing, however folkloric or arcane they seemed to be on the surface (H. Butlin, quoted by Munro 275).
Work Cited
The Answer of Richard Guy, Surgeon, in Mark-Lane, to certain invidious Falsehoods and Reflections upon his Method of Curing Cancer without Cutting, lately published in an Introduction to the Essays, &c. of Thomas Gataker, Surgeon Extraordinary to his Majesty, &c. Proper for the Perusal of all those, who are, in any Degree, afflicted with Cancers. London and Westminster: R. Willock and W. Bristow, 1764. Review by A Society of Gentlemen. The Critical Review: Or Annals of Literature. London: A. Hamilton, 1765. Google Books. Web. 7 March 2017.
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(17 January 1857) Vol. 1/Vol. 14: 55-7. Google Books. Web. 8 March 2017.Stone, William B. "A Review of the History of Chemical Therapy in Cancer." Medical Record. Ed. George Frederick Shrady and Thomas Lathrop Stedman. (7 October 1916) 90.15: 628-34. New York: William Wood & Company, 1916. Google Books. Web. 4 April 2016.
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Wigglesworth, Jr., Edward. "Subcutaneous Injection of Corrosive Sublimate in Syphilis." Boston Medical and Surgical Journal. (26 August 1869) 4.4/81: 49-51. New England Journal of Medicine. Web. 8 March 2017.
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Last modified 20 March 2017