ohn Pattison (d. 1876), who received his medical degree from UMC/New York University in 1843, requested permission from the Governors of Middlesex Hospital (London) to conduct a clinical trial of a unique anticancer agent ("Pattison," 4; Cancer: Its Nature , 129-33). After considering his November 1852 prospectus, the Governors summarily rejected it (, 133). In 1857, the same Hospital granted Dr. Jesse Weldon Fell permission to test a similar escharotic compound in the cancer ward. The inconclusive trial results, along with questions regarding the doctor's pecuniary motives, would contribute to the fierce, ongoing debate between allopathic (i.e.,"the method or treatment of the old school medicine") and homeopathic practitioners over how to treat cancer (Hahnemann, "Allopathy," 736).
In the 1860s, undaunted by the hostility of allopathic surgeons, and to establish the legitimacy of escharotic practice, Dr. Pattison, once again, advertised his dual-action compound of Hydrastis canadensis and zinc chloride. Before he could make a case for the uniqueness and value of his nostrum, however, he had to correct the public misconception that it was he, rather than Dr. Fell, who had organized and conducted the failed 1857 investigation at Middlesex Hospital:
A statement has been widely circulated that I had a ward given to me at the Middlesex Hospital for the treatment of cancer, that this treatment was totally unsuccessful, and that the patients could not submit to its severity. In all this there is not one word of truth. My name has been confounded (I hope unwittingly on the part of my medical brethren), with that of an American adventurer, to whom a ward in the Middlesex Hospital was given some nine years ago, and whose treatment was to burn out the diseased part by the use of zinc chloride. (Pattison, Cancer: Its Nature (1866), 15.
Even before the Fell trial at Middlesex had been completed, Pattison complained of how resentful conventional surgeons had been towards him for advocating the effectiveness of caustics. "They assault me with calumny and falsehood," he wrote, "and call me an Empiric and a Quack." To undermine his medical practice, they communicated malicious accusations to patients: “Indeed, hardly a day passes that I am not informed, by friends and patients, of the bitter feeling against me among my professional brethren" (Cancer: Its Nature and Treatment , 83, 84, resp.). In this rancorous climate, Pattison hoped to prove the effectiveness of zinc chloride compounds against breast and skin cancers; and, after securing a patent, to accrue profit from its use.
Dr. Pattison's 1852 Trial Prospectus
Pattison's 1852 prospectus was loaded with conditions designed to ensure his exclusive rights to a caustic paste comprised of Hydrastis canadensis or golden-seal and zinc chloride (Millspaugh, 63-6; Pattison, , 132). Although it is unclear as to whether he masked the presence of zinc chloride, he implied that the botanical ingredient was the primary escharotic. As early as 1851, it was known that both golden-seal and zinc chloride could devitalize human tissues. The pharmacologist Alfred A. B. Durand, in 1851, reported having isolated golden-seal's active ingredient: the alkaloid crystal C22N23NO6. The plant extract had been used in North America by Native tribes as a medicine and a dye; and it was used as a topical corrosive for inflamed ulcers (Durand 113; Millspaugh 65). Pattison, it appears was wielding a very powerful, dual-action compound.
Pattison and the Governors of Middlesex Hospital discussed the prospectus in correspondence, from 17 to 23 November 1852 (, 79-81). He knew that he had to be forthright about his intentions and about the composition of the anticancer ointment. Although willing to disclose the active ingredients (H. canadensis and zinc chloride), he refused, for good reason, to allow this information to be generally known beforehand. Had the formula been leaked, it was possible that anti-homeopathic sentiment could have subverted the investigation on principle: that the plant extract was exotic or that the zinc chloride, though known, was arguably of limited value. One way to satisfy the requirements of the Governors and to safeguard his ownership of the formula was to enlist an external medical expert to superintend the investigation. Only a consulting surgeon would know precisely what its chemical composition was. Prepared to confide in "any one surgeon of a well-known standing," Pattison nominated two candidates: Dr. William Lawrence (1783-1867) and Dr. Benjamin Collins Brodie (1783-1862). In hindsight, nominating the surgeon/chemist, Benjamin Brodie, was risky, for Pattison might not have known, in 1852, that Brodie was no friend to irregular and homeopathic medicine (Brodie 337-40).
Pattison knew that the Governors had the prerogative to choose whomever they liked; but, according to his ironclad plan, whoever was appointed would be contractually bound to secrecy and not even be able to prescribe the paste without Pattison’s written consent. Once the investigation was completed, the superintendent would then inform the Honorable Board as to its safety and oversee the patients who had been treated. Thus, Pattison had articulated an ingenious plan to legitimize the formula while keeping the entire process under his jurisdiction. The 20 Middlesex Hospital patients were to occupy a single ward, under the care of the superintendent, Dr. Pattison, and a team of "trustworthy nurses" (, 132). Pattison might not have realized it at the time, but his call for a small, mixed cohort of 20 patients would not have yielded consistent information. Pattison appears not to have taken into statistical account the age and sex of patients, the type and stage of the disease in each case, and co-morbidities, if any.
Pattison demanded exclusive rights to wax representations of the tumors: hence, drawings or models of the worst cases of disease were to be made before and after the removal of a tumor. These artifacts, for which the Hospital would pay, were to become his property, along with all anatomical specimens. Realizing that escharotic surgery had limitations, he even audaciously redefined a "cure" to be a condition in which malignant tissue had been extirpated during the trial: the person from whom the tumor had been removed and who was left with a healthy sore, "shall be considered as cured," and the House Surgeon shall be responsible for post-operative care. Compliant with the definition, The Honorable Board shall officially proclaim that Dr. Pattison's paste had cured superficial cancers. No mention was made of remission periods or of recurrent disease (132).
Not surprisingly, in a 30 November letter, the Medical Committee and the Board of Management rejected Pattison’s prospectus on the basis of the Institution’s long-standing disclosure policy: surgeons were required to keep thorough medical records of their patients, to report extraordinary circumstances during the course of treatment, and to reveal, "for the benefit of society," any "providential" discovery (Pattison, , 82; , 133). Pattison's conditions made this impossible.
1860-1866: Identity Lost & Regained
In 1860, as noted in the opening paragraph, Pattison learned that another chemical surgeon, conducting a trial of a zinc-chloride compound in 1856-1857, had not only failed to demonstrate the superiority of caustics over ablation, but had also been exposed as a profiteer. This revelation directly interfered with Pattison's strategy to legitimize his surgical technique and to establish a lucrative practice. Middlesex Hospital, it appeared, had "solicited a foreign adventurer to try his method of cure, which proved to be a complete failure" (Pattison, , 129). The so-called "foreign adventurer" was none other than Dr. Fell: an American by birth, an NYU Medical School alumnus of Pattison's, a zinc-chloride practitioner, and a person derided in the press as a quack. Even worse, according to Pattison, was that the public had mistaken him for Dr. Fell. Thus, before Pattison could build his practice, he had to correct the public misconception about the trial and the erroneous charge that he was responsible for Mrs. Emile Gosse's suffering. In the 1866 text, Pattison expressed indignation that the Emily Gosse case had been imputed to him:
I have lately been told by several patients that they had been informed that Mrs. Emily Gosse had been under my care, whose cruel treatment and sufferings are recorded in a little book entitled 'Tell Jesus.' This lady was never under my care, nor have I ever had the pleasure of meeting her. She was under the care of the person referred to in the above paragraph [i.e., Dr. Fell], and no doubt her sufferings were aggravated, and her life shortened by the barbarous employment of pure chloride of zinc. [Pattison (1866), 15]
With career and reputation at stake, Pattison strongly rebuked Fell, but, in so doing, might have gone too far. He did not consider the fact that, in the Emily Gosse case, Dr. Fell had been confronted with an aggressive cancer that neither knife nor paste could defeat; in fact, it had metastasized, despite Dr. Fell's best efforts ("Tell Jesus", 116). Pattison unjustly charged Fell with using pure zinc chloride; rather, the latter's formula mixed S. canadensis, the chloride, and other substances in measured proportions. Mrs. Gosse's case was also quite complicated. On the one hand, Pattison's statement that Dr. Fell's treatment was "cruel"—i.e., the source of merciless and gratuitous pain—seems to have been intended to villainize the attending physician. In"Tell Jesus", Anna Shipton wrote that Emily Gosse certainly endured "terrible torture" — the protracted pain of escharotic surgery as a last-ditch measure for terminal cancer—and, at the outset, that Dr. Fell had confidently predicted "a happy issue"; but no explicit criticism or condemnation of the doctor appears anywhere in the text. Of the fragments of information that surface, several are noteworthy: Mrs. Gosse had "a strong predilection in favor homeopathy" (47); thanks to Fell's treatment, she experienced a period of "manifest improvement" (140); and she suffered from both consumption and cancer — a diagnosis of co-morbidity prompting a second physician to state that "either of the diseases might be the immediate cause of death" (140).
Once Pattison had cleared away the innuendo, he began to cultivate a professional image. Offering an unambiguous explication of his method, along with case studies of its use and results, he attempted to remind authorities, already wary of American-educated surgeons who used caustics, that he was a Scotsman by birth, that his credentials were valid, and that he was no pretender. To some conservative physicians, a wielder of plant extracts was a quack until proven otherwise; and others, made cynical by the outcome of the Fell’s trial at Middlesex, prejudged in this manner. Those who denounced Fell’s unsupported claims and dubious activities were inclined to reject S. canadensis or a similar nostrum.
1866: The Method Redivivus
Hydrastis canadensis from Charles F. Millspaugh [author and illustrator], American Medicinal Plants (1887). Click on image to enlarge it.
In 1866, Dr. Pattison publicly unveiled his anticancer wonder drug, combining in a paste chloride of zinc and H. canadensis. The effects of ZnCl2, by this time, were very well known. He finally admitted that the botanical, as a caustic, exerted "a specific effect on the disease itself" (, 89-90). The pharmacological and medical literature, which Pattison should have cited, but had not, supported the assertion that botanicals, such as Hydrastin, Phytolaccin, and Heloniadine, had "anti-cancerous action" (, 12-13, 97). When it came to treating the aggressive and intractable skin cancer known as noli-me-tangere, Pattison was right to believe his chemical method, which involved a number of substances, brought new hope (, 13; T. D. Williams 239).
Pattison outlined his method in detail. He duly credited the innovations of forerunners, Justamond and Girouard (, 90). His paste—a variant of Fell's — consisted of equal parts of the powdered botanical and of the chloride, in flour and water. To blister the skin when the tumor was on the surface and to ensure that the compound would be absorbed, he applied nitric acid for 10-15 minutes. Once the skin had peeled away, he applied an ointment of 10% active ingredients and 90% calendula, yellow-flowered herb related to daisies. The mixture was swabbed over the blistered surface and began immediately to coagulate the tumor (, 91). The strength of the ointment was gradually increased until, by the fifth or sixth day, the area had been desensitized. At this point, Pattison cut perpendicular lines, as per Justamond, about 0.5 inches apart with the point of an instrument. Since the scratched lines were made in desensitized tissue, there was no pain. He dressed the exposed and scored surface with narrow strips of cambric, over which undiluted paste had been spread. The dressing, retained in place for one or two hours, was to be changed daily until the tumor had been completely removed and nothing but a healthy sore remained (, 92). Reportedly, the patient had only the sensation of heaviness caused by the dead tissue.
To complete the process of coagulation and detachment, Pattison dressed the mass with calico strips about one inch apart, spread with calendula ointment. The strips were placed around the mass, one half of the breadth laid on the untreated half of the tumor, the other on the dead half, and the strips were changed daily. By the tenth day, as the bulk of the tumor began to peel away from the surface, Pattison discarded the calico strips, substituting for them cotton-wool treated with calendula (94). The average time for the complete detachment of the mass was sixteen days. The dead masses frequently fell off when the patient was in bed or when dressing. After the mass detached, bleeding ceased, and a flat sore was exposed. These dressings are repeated until the surface of the sore was clean and devoid of any visual disease; diluted paste was applied to any suspicious area. Pattison used a number of botanical mixtures to promote healing, in addition to H. canadensis (97). With the way seemingly clear of obstacles, Pattison who stood his ground before detractors practiced escharotic medicine with renewed confidence.
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Last modified 29 March 2017