DEP/DUA/1/42/37 (Transcript version)

Duncan Stewart

(1787-1788)

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Duncan Stewart at 77.

In case of this patient as formerly obs. have a decided ex. of Cancr.

And that too whether [consider] extent, state of app. state of disch, or pain with which attend evid of worst kind.

And attempts hitherto made to cure of no effect.

Nor can even be said to have had any influ as mitig pain or allev other sympt.

Hence no reason to alter former opin that will prove fatal.

And that event am now inclind to consider as not far dist.

For patient not only now entirely conf. to bed, but even there can enjoy no rest.

Reason therfore to presume that constit soon worn out.

And that from superv. febrile access, convuls, syncop, or like will be cut of.

For in all these ways, patients fall victims to this disease.

But although under our care disea has made usual progr. yet prosp of recov. little less better then, than at pres.

For must be allowed that Cancr long & justly rankd among [opprob] medic.

As little acq with cure, on an empyr, as on dogm footing.

For of nature of this affect, in my opin at least, no prop or satisf acct has yet been given.

Evid however see it exist in two states.

Those viz disting by appellat of occult, & open cancer.

And perhaps may even add to these a third.

That viz of schirrus.

For although cannot be alledgd that every schirrus degen into Cancer, yet certain, that not unfreq. a transit from one state to the other.

And wherever severe pains arise from a hard indol. tum. & skin over it becomes corrig. may consid it as passing into state of cancr.

For these evid conseq of cancer virus as it may be calld gener at part.

Cannot indeed adopt opin of those who suppose that disease of partic part prod from Cancr virus [exis] in mass of fluids.

But no doubt that a pecul matter gener. at part.

Of this unden. evid even prev. to any ulcert. from affect of other glands induced in conseq of [abcs].

And from certaint that disease induced in these partakes of same nature.

To matter thus gener. as to ascr. many of worst sympt.

Partic want of dispos. to heal, severe pain, & sense of excess heat.

For any thing we know, this separ in no degree conseq of pab.

For while cancer exists in one part, separ & secret from others, in perfectly sound state.

Hence necess led to attrib. form of cancer virus, to pecul depraved action in vessels of part.

But how this depravd action ind. or in what it consists do not pretend to say.

Even this conj. however perh not altog without use in pract.

For leads us to consider cancer as being at first at least a local diseas

And as affect syst. only be [illegible] gener. at the part.

Hence ground for expect that be compl. remov. at suff. early [period] cure may be obt.

Not indeed to be expected that operat will remove virus already introd into the syst.

But this conseq only of delay. And where by means of it compl. removal can be effected, does more than all other modes of cure put togeth.

Am therfore of opin that ought never for a mom. to be delayd in expect of cure by other means.

But diff. circum from which becomes inadmiss.

There remains only to attempt cure by other means.

In these circum recourse had to various remed, which recomm as have sometimes been attended with success.

Partic Cicuta, [Verruc], [Aeg], & [Onan].

All these readily admit to be artic of very consid activ.

And that may have succeeded in some cases am far from denying.

But can have no doubt in assert that from many of them success but a rare occurr.

And have reason to susp that to some of them partic Cicut. recourse had before pat. came under care

From this led here to make trial of anoth med of late in som esteem.

viz the Belladonna or Deadly Night shade the Arop. Belladon of Linn. the Solan. [Furios] of some other Botan

This artic need hardly obs. long ranked among most virul. pois.

And from accid use of diff. parts partic berries, even to small extent fatal conseq have often ensued.

Notwith this however now for a consid time in use as med.

And espec. as empl. both exter & intern in cases of Cancer.

With this intent. long used extern in Brit. as app. from writings of Ray & others.

And some well vouchd inst [which] in this way remark success.

Partic one not long since pub. in Med Comm. by Dr Graham of Stirling.

And in this way though not always inno. yet reason to believe is one of most powerf. resolv. with which yet acq.

From extern Phys. prob. passed to intern use.

And in this way about begin of pres cent. empl. under form of weak watery infus by Junker Degnerus Timmrman &e.

In 1739, a treatise written profess. with respect to it by Dr Oetinger at Halle.

De Belladonna, tanquam specifico in Cancro, imprimis occulto.

In 1754 anoth by Dr Lambergen. Lectio inauguralis sistens ephemeridem persanati Carcinomatis.

But in conseq of these never cam into gener. use.

And while in some inst. faild of prod cure, prod of alarm conseq.

Were however suff. to shew that in partic inst might be empl. with impun & with adv.

Very lately again recom to attent of Phys. in a treat. pub. at Goet by Dr Munch.

Disseratio medica sistens Obvervationes practicas circa usum Bellad. in Melancholia Mania & Epilep.

By this treat has of late [come] into some fash. both in these diseas & also in cases of Cancer.

Before chiefly [used] under form of infus.

But by Dr Munch, recomm with greater prop in that of powdr or pills [formd] from the powder

For by this means most cert. that activ not destroyd by action of heat.

While slow & grad infus is as it were formd in stom.

To this formul. therefore had here recourse.

Mass formd by means of soap div. into pills each cont. 1 gr of Bellad.

From activ of med was necess that should be empl. with great caut.

Directed therefore only a single pill at bed time.

While this taken intern, was necess to empl. some topic treat.

And with this intent directed ulcer to be dressd with Saturn. Oint.

Which while a soft & gentle [appl] has at same time more than alm any other ointm effect of cooling parts.

An effect which from intolerab sense of heat with which pat dis here partic necess.

But at same time, could expect nothing from it as tending to radic cure of affect.

And if under this course change for better had been induced could attrib it only to Belladonna.

On Belladonna pat. continued for week.

And as not prod of any sensib operat. had reason to conclud [that] might be encr.

This the rather necess as [some] contin in every respc. as before.

Directed therfore contin to triple former quant. three grains a day.

One in morning & two at bedtim

Still however no sensib operat. of any conseq.

At least utmost effect he could perceive slight sickness from ever dose.

Was indeed now more affected than formerly with gener. flushings heat & dryness of mouth.

But this no more than might naturaly be expected in prog of dis.

And indeed is very commonly by viol febrile access that patient cutt of in Cancer.

And with pat. in situat of ours with pulse alm perman. above 100, such to be expected.

But while no inconv from med had as little influ on sore.

And pain in partic contin as viol as ever.

In this situat then nothing to deterr from still farther augm.

Could not however prop. to encr. with same rapid as before.

Espe as from the two gr. some sickness at stom.

Merely ordered therefore two gr for each dose.

From this quant. thought pain somewhat mitig for an hour or two after taken.

But whether this effect of med or not was both inconsid & but tempor.

Now however compl. nothing of of sickness.

Hence directed even dose to be augm to three grains.

Though slight dimin of pain yet no change in condit of [sore]

And was even more than ever affec with distress. sense of heat.

To countr or at least to mitig this, besides cont of Saturn oint. directed careful lotion with Saturn solut.

But after fair trial without effect.

And whether former mitig of pain effect of Belladonna or not now app that quant taken inad to that effect.

For pain more severe than ever.

Besides therefore encr. dose of med to three gr twice a day, directed also an opiate at bed time.

But as at same time taking anoth very remark narcot. would have been imprud to begin with large dose

Directed therfore gr XV of Pil Theb. cont. Opium gr i s.

This indeed may be consid as suff. dose at comm.

But to be rememb. that our patient under influ of severe pain.

And cert. that in that condit. not only born with impun. in large doses, but such doses requis for prod any effect.

Indeed hard to say to what [exten] from influ of pain & habit may not be pushd.

Have from indub author been informed of one case in which Liq. Laud. taken to extent of ℥IV ter de die.

A quantit suff. to kill 20 people in state of health unac. to use.

Have no doubt therfore that migh at first have dir it with impun. to much greater extent.

But for reasons already given reckond it necess to begin with prud.

While at same time am fully conv that benef of Opium often lost from being overd as well as underdosed.

Have now howevr directed it to double quantity.

Substit to Pil Theb. a pill of Opium alone.

This if not prod of desired effect shall prob. encr. even to double quant.

Must howevr again repeat that am no friend to habit use of large doses of opium.

For whether answ. intent of prod [term] mitig of pain or not very gener. [illegible] constit in other resp.

And where prop. of contin being requis for some length of time, should I think seld exceed five or six gr.

And from this often more benef. than from double or even triple quan.

But while encr. opium shall also prob. still farther encr. Belladonn

Giving it perhaps to extent of ten or twelve gr in day

But that quant. should be [illegible] to exceed

And indeed must be conf. that little encour. to persist in use from any app. of change to better.

But see no change that can be made with any prosp. of success.

And after begin use wish to give it here fair trial.

Must however obs. that failure of success in this inst will not lead me to any conclus against it.

And on other hand extent to which here born without obv op. no rule for other [cases].

For may inferr that effect of Belladonna as well as of opium [countracted] by severe pain to which patient subjected.