CHAP. II.
Concerning the Opinion, that Mercury cures theLues Venereaby the evacuation it produces.
Thereare few medicines with regard to the operation of which all practitioners are agreed. It is, however, by no means incumbent on him who means to establish the truth of any one opinion to overturn every hypothesis advanced on the same subject. But, as the arguments urged in favour of any hypothesis will have much less weight when another is previously believed to be true, and as the regulation of practice is, in every case, to a certain extent, founded upon theory, no inconsiderable advantage may be derived from overturning an ill-founded opinion,especially when it is generally received. The theory of the action of mercury, as well as of other substances, has afforded room for a diversity of opinions. For the reasons mentioned above, then, although it is by no means intended, that every opinion, with regard to the operation of that medicine, should here be considered; yet, as it is a very prevailing opinion, that the good effects obtained from mercury in the cure oflues venerea, depend upon its action as an evacuant; and, as a variety of seemingly strong arguments have been adduced in favour of that hypothesis, it will be necessary to examine how far they are sufficient to establish its truth.
In favour of the opinion, that mercury cureslues venereaby acting as an evacuant, the following arguments have beenemployed. It is alledged, that the good effects obtained from mercury in the cure of this disease, are in proportion to the evacuation which it produces; that the cure produced by mercury depends more upon the stimulant power of the preparation which is employed, than upon the quantity taken; and that the same good effects are obtained from other evacuants as from mercury; particularly, that the venereal disease is cured in a similar manner from the employment of guaiac. The arguments here enumerated, if not the only ones upon which this opinion is founded, are at least those which are principally employed. To examine, then, how far these are well founded, will be sufficient.
The first argument here adduced is, that the good effects of mercury are proportioned to the evacuation which it produces.This assertion, if allowed to be true, might, at first sight, appear to be a very strong argument in favour of the theory here adopted. But it is strong in appearance only; for, although it should be admitted, it in fact proves nothing.
But, even previous to this, it might be made a question, how far what is here assumed as a fact is well founded? And if it should appear, that mercury does not curelues venereain proportion to the evacuation which it produces, a strong argument might from thence be brought against this theory. But what may be said on this question will, with greater propriety, occur when the objections to the theory come to be adduced, than in attempting to refute and invalidate the arguments brought in its favour. At present, it will be sufficient to show, that,even allowing it to be true, it is no argument in favour of the supposition.
If it be true, that mercury cureslues venereain proportion to the evacuation it produces, it may indeed, with some degree of probability, be concluded, that the evacuation and cure are not unconnected. And, if the evacuation is not the cause of the cure, it might at least from thence be inferred, that both of them depend upon the same cause; but it no more, unquestionably, follows from thence, that the evacuation is the cause of the cure, than that the cure produces the evacuation.
The degree of evacuation which, in any case, arises from the employment of mercury, will, it is natural to imagine, be proportioned to the quantity of activemercury which is introduced into the system. But, in whatever way mercury acts in the cure of the venereal disease, it may then be supposed to act most powerfully when it is present in the system in most considerable quantity. In this point of view, then, the evacuation which arises from the use of mercury is to be considered merely as an index of the quantity of the medicine which is introduced into the system in an active state; and the cure may be proportioned to the evacuation, only as pointing out the degree in which the mercury exists in the habit. Even supposing, then, that the foundation upon which this argument is built were not to be called in question, yet, taken in its greatest latitude, it is still at best but doubtful; and from it no conclusion can be drawn in favour of the theory which it is brought to support.
The second argument mentioned in proof of the supposition that mercury acts, in the cure oflues venerea, as an evacuant, was, that the cure produced by mercury depends more upon the stimulant power of the preparation employed, than upon the quantity of mercury which is used.
This argument may be answered in the same manner with the preceeding. It is indeed true, that different preparations of mercury, when used in equal quantities, have by no means equal influence in the cure oflues venerea. There is seldom an opportunity of observing what would be the effects of the most stimulant preparations, as, in the venereal disease, they are by no means in common use; and as, from their action on the alimentary canal, they exert very violenteffects, without entering the circulating system. They, in general, operate very roughly, both as emetics and purgatives; but it is not clear that, in the venereal disease, any benefit has been obtained from their effects in either of these ways. It can therefore by no means be allowed, that the foundation of this argument, in its full extent, is strictly true. It cannot indeed be denied, that some preparations of mercury, which possess a considerable stimulant power, have a greater influence in the cure oflues venerea, than several others which are less stimulant. So far, then, the foundation upon which this argument is built, must be allowed to be just, and its weight, as tending to establish this theory, requires a refutation.
But, even admitting it to be just, without any reserve, still, no more thanfrom the former, can any conclusion be drawn from this in favour of the theory which it is meant to support. It has already been observed, that, in whatever way mercury operates in the cure oflues venerea, its good effects may always be supposed to be proportioned to the quantity of the medicine which enters the system in such a state as to become active there. But the quantity of active mercury entering the system can in no case be judged of from the quantity of the preparation which is employed. One preparation of mercury much more readily admits of a mixture with the animal fluids than another; in consequence of this, it will find a more ready entrance into the system. And further, this variety in the facility of access into the system, not only holds in differentpreparations, but even in the same preparation at different times.
In proof of the first of these propositions, we have a convincing example in the difference which is observable between the effects arising from the use of crude mercury, and of this metallic substance, when no other means are used to render it active than simple trituration. It is well known, that even a very inconsiderable quantity, taken in this last way, will soon shew its effects at the most remote excretories of the body; in the other, although swallowed to the quantity of many pounds, it is a very rare occurrence that any effects can be observed from which it can be concluded, that it has, in any degree, entered the mass of circulating fluids.
But it was likewise alledged, that mercury, used at different times, although given in equal quantities and in the same form, produces very different effects. Crude mercury, as has already been observed, although swallowed in considerable quantities, rarely produces any other effect on the body, than what arises from the passage through the alimentary canal. This, however, although generally, is not universally the case. On some occasions, when taken in this way, it operates with as great activity as when used in any other form; and, from many well attested instances, it appears, that, by being swallowed even in a crude state, a high salivation has been excited. In this we have an instance in which a remarkable difference of effect arises from the employment of the same preparation at different times. This differencecannot arise from the quantity of mercury employed; for while, in some cases, no operation of the nature here mentioned takes place from the use of a large quantity, in others, it will be excited where an inconsiderable quantity only has been taken. The difference of effects here observed, then, must be ascribed to some other cause; and it is most reasonable to refer it to particular accidents in the constitution at the time the medicine is used. In these cases, where no operation takes place from its use, it may be concluded, that the whole quantity of mercury swallowed has passed through the alimentary canal in the same state in which it was taken in. When, on the other hand, an operation upon the salivary glands, or any other excretory remote from the alimentary canal, is observed from the use of crude mercury, it may be concluded,that part of the mercury, from some peculiarity in the habit at the time, such, for example, as the presence of superabundant acid in the stomach, has been brought into such a state as to be capable of entering the circulating system. From these instances, then, it evidently appears, that the facility with which mercury enters the system, admits of very great variety. And from this a strong objection may be adduced against the argument here brought to support the hypothesis that mercury cureslues venereaby its evacuant power.
It is alledged, that mercury cureslues venereaby the evacuation it occasions; because the good effects derived from its employment are observed to be more in proportion to the stimulant power of the preparation which is used, than to thequantity of mercury taken. The data, however, here assumed by no means lead to the conclusion deduced from thence. The most stimulant preparations of mercury, by their action on theprimæ viæ, are in general immediately expelled from the system. When this happens, they have no influence in the cure of venereal complaints. When they are not thus expelled, their nature is such that they most readily enter the system. Their superior action, then, may be accounted for without supposing that it depends on their producing the most considerable evacuation.
From the facts as here stated, it indeed follows, that the good effects obtained from mercury are greatest in those cases in which the mercury enters the system in most considerable quantity. The evacuation,it is true, is then likewise greatest. But this will unquestionably follow as the necessary consequence of the presence of active mercury in the system, and can by no means be concluded to be the cause of the cure. The evacuation which occurs in this case, then, as was observed in the objections adduced against the last argument, can be considered only as an index of the quantity of active mercury which is present in the system. The superior activity, therefore, which some stimulant preparations possess, when compared with those of a milder nature, is by no means a proof of the supposition that mercury cureslues venereaby means of the evacuation which it produces; and this argument, as well as the former, may be set aside.
The third argument mentioned in favourof this theory, and the last which we proposed to consider, is, that the same good effects, in the cure oflues venerea, may be obtained from the employment of other evacuants, as from that of mercury; and particularly, that the venereal disease is cured in a similar manner by the use of guaiac.
This argument, if well founded, would indeed be a conclusive proof of the theory, in support of which it is here adduced. Evacuation may be occasioned by a great variety of other means besides mercury. The influence of any discharge, as tending to curelues venerea, will fall more particularly to be considered in stating the objections against this theory. A full answer, then, to the first part of this argument, would at present be superfluous: But it may be observed,that it is by no means a common practice to attempt the cure oflues venereaby the safest and most effectual evacuants now in use; and that, when evacuants are employed for the cure of other diseases, while a venereal infection at the same time exists in the system, it is never found to yield to them. This first part of the argument, then, may be shortly answered, by denying it to be true.
It is indeed true, that much benefit has been alledged to be obtained from guaiac in the cure of thelues venerea. Experience, however, has sufficiently demonstrated, that these testimonies are not altogether to be relied upon. The influence of guaiac may perhaps be very considerable in certain stages oflues venerea, when the malignity of the disease is already overcome by means of mercury;or in particular climates, where the nature of this infection seems to be in some degree different from what it is in this country. But, how far the good effects of guaiac are established by facts in this climate, and before a cure has been attempted by mercury, is still a matter of great doubt. And, at any rate, even the most sanguine advocates for the use of guaiac will allow, that the good effects obtained from its use are by no means to be put in competition with those which are derived from the employment of mercury.
But, even admitting all that has been said in favour of guaiac to be strictly true, still it does not follow, that it cures thelues venereaby evacuation. Many medicines which operate much more powerfully as evacuants have nosuch effect. And, what was formerly said with regard to the cure oflues venerea, being proportioned to the evacuation produced by mercury, may perhaps, with equal justice, be applied to guaiac. It cannot be, with certainty, concluded, that the evacuation in either case is to be looked upon as the cause of the cure, since, in both, it may only be its concomitant. From this argument, then, nothing can be inferred, which has any tendency to establish the truth of the theory in support of which it is adduced.
Thus have we examined the different arguments used in favour of the supposition, that mercury cureslues venereaby acting as an evacuant. And, from this examination, it appears, that they admit of satisfactory answers. Whathas then been said in proof of the theory, can by no means be considered as sufficient to establish its truth. But the insufficiency of the arguments adduced in support of it, is not the only reason for not adopting it. There are many objections to this hypothesis, which would have been sufficient for rejecting it, even supposing that the arguments brought to prove it had been such, that no falacy in them could have been detected. That this theory, then, may, with less hesitation, be set aside, it will be necessary to mention a few of these objections.
It obviously occurs as a first objection to this theory, that evacuation, from its nature, cannot easily be supposed capable of producing a cure oflues venerea. The changes which evacuation may produceupon the fluids of the body, can only be conceived to be of two kinds. They must either depend on a diminution of the quantity of the fluids, or on a change of their quality. But, it is not easy to conceive how the effects of thevenereal virusshould be removed, or on what footing this virus should be expelled from the system, by either of these changes, when induced by evacuation.
A mere diminution of the quantity of circulating fluids, is certainly insufficient for the cure oflues venerea. The venereal matter, as present in the body, must either be diffused through the whole mass of fluids, or confined to particular parts only. If it be diffused through the whole mass, the taint, even after the most considerable evacuations, will remain equally strong in the fluids still left in the body. And, as the venerealvirus evidently possesses a power of assimulation, when in the human system, the whole mass of fluids would soon return to its former state. This being the case, then, it must be allowed, that an inconsiderable diminution of quantity cannot reasonably be supposed to counteract an infection which exists in the remaining mass.
If, on the other hand, the venereal poison be supposed to exist only as a noxious matter in the body, when collected at particular parts, it is equally difficult to conceive, how evacuation from its nature should produce a cure. It never has been observed, that mercury particularly encreases the discharge by those parts where the venereal matter appears actually to exist. In almost every case where it is used only internally, there isno encrease of evacuation by venereal ulcerations. It cannot, however, be imagined, that a discharge which takes place by the salivary glands or skin, will particularly evacuate what is lodged in the genitals, or extremities. We may therefore, with certainty, conclude that evacuation does not at least curelues venereaby any change arising merely from a diminution of the quantity of circulating fluids.
Evacuants may perhaps be alledged to operate in the cure oflues venereain another manner. It may be supposed, that they remove the distemper from a change which they produce in the quality of the circulating mass. But, from the smallest consideration, it will appear, that this supposition is equally unsatisfactory as the former. If, fromevacuation, a diminution takes place equally from every part of the mass of circulating fluids, no change of quality will ensue. If, however, this proportion is not properly observed, a change of quality will indeed take place. But that change will consist merely in the diminution of particular parts in a compound mass, and can never be supposed to remove a contagious matter of any kind, even supposing it to be lodged in the particular part of that mass thus diminished. Much less will it remove an infectious matter uniformly diffused through the whole parts of the compound mass, or existing as a morbid matter in particular parts of the body only. From the nature of evacuation, then, whether it be supposed to operate by a diminution of the quantity of circulating fluids, or by any change itcan produce in point of quality, it may readily be concluded, that it is by no means fitted for the cure oflues venerea.
Another and more conclusive objection against the supposition that mercury cureslues venereaby evacuation, is, that this disease is by no means cured by evacuation taking place in an equal, or even in a greater degree, from other causes. This, however, should of necessity be the case, were the former supposition well founded. Effectually to overturn this theory, then, it will be necessary only to establish the truth of this assertion.
It cannot perhaps be alledged, that any fair trial has ever been made of evacuation, instituted solely with a view tocure the venereal disease, and that in such cases it has been found to fail. But, without any such trial, there are sufficient arguments to shew, that for this purpose it really is ineffectual.
Lues venereawould never, upon its first introduction, have been considered as so unconquerable a disease, could it have been cured by evacuation. Various modes of evacuation were then in common use in medicine, and considered as the most effectual means of cure in many diseases. The venereal distemper, till the introduction of mercury, resisted the power of almost all the medicines employed against it; and, in some parts, it was at that time reckoned so incurable, that the police of the country obliged the unhappy sufferers who laboured under it to separate themselves from all intercoursewith the rest of mankind. While this was the condition of the distemper, is it to be imagined that every method of cure was not tried? May we not, then, conclude, that, upon the first introduction of this disease, evacuation, by every known means, and carried to the greatest height, was had recourse to, but without effect?
But, to prove that evacuation will not cure the distemper, it is needless to travel back to the first periods of this disease, or to rest the evidence even upon the highest probability. From what occurs in many morbid cases, we have every day evident proof of the insufficiency of any discharge for producing a cure of the venereal disease.Lues venereaoften exists at the same time with diseases in which an increase of natural evacuationstakes place. None of these diseases, whether the evacuation happens by the salivary glands, as in small-pox, by stool, as in dysentery, or by the skin, as in intermittents, have ever been found to break its force, much less to produce a perfect cure.
Besides what happens in natural evacuations, we have likewise proofs of the insufficiency of artificial evacuations for the cure of this disease. Although evacuation, at least by other means than by the use of mercury, is never now employed as a cure for the venereal disease; yet venereal complaints are often complicated with others, for which various evacuations are proper. And while evacuations are, with success, employed for the cure of these, it is found, that the venereal taint either remains unchanged,or is even increased in force. It cannot here be alledged, that the difference of effect depends upon the mode of evacuation. On such occasions, every mode of evacuation has been tried with equal want of success. Even salivation, which was long considered as the only effectual discharge, when excited by other means than by mercury, or even by mercury itself, when externally applied to the organs secreting saliva, has not been found more effectual than other modes of evacuation. In some cases, indeed, mercury received into the mouth by steam, or otherwise, has had good effects; but these were either to be accounted for from its application to the diseased part, or from its introduction into the system. It is, then, sufficiently evident, that evacuation, at least by othermeans than mercury, does not curelues venerea.
To this theory it may be urged as a third, and not less powerful objection than any of the former, that where the evacuation arising from the use of mercury inlues venereais the greatest, the cure is often retarded; and that mercury never more frequently fails than in those cases where it begins to evacuate upon its first introduction into the system.
That these assertions are true, at least of the obvious discharge produced by mercury, will not be refused by any advocate for its action as an evacuant. To this, indeed, they may think it a satisfactory answer, that the influence of mercury as an evacuant cannot be judged of from the apparent discharge. It may be alledged,and indeed with some appearance of reason, that the greatest discharge produced by mercury is by insensible perspiration; that mercury, in consequence of this, is a more powerful evacuant than many other medicines by which a greater obvious evacuation is produced; and that it has the effect to increase perspiration in a more remarkable degree, when it increases no other discharge than when it induces the greatest obvious evacuation. But although it cannot be denied, that the use of mercury does increase insensible perspiration; and that evacuation in this way may, on some occasions, be greater than what would arise from salivation or any other obvious discharge; yet these facts by no means tend to any conclusion which will remove the difficulty formerly stated. Nor can it from thence be supposed, that mercuryalways evacuates most powerfully in those cases where it produces the most successful cure.
The degree of evacuation which takes place from the employment of any medicine cannot indeed, in every case, be ascertained by the obvious discharge. But, where the judgment formed from this test would be fallacious, the marks of inanition consequent upon the use of any medicine are always certain tests for determining the degree of evacuation. From these it is evident, that the suppositions here advanced, that mercury operates more powerfully as an evacuant than any other medicine, and that it always produces a greater discharge when it acts by the skin, than when it affects the salivary glands, or any other excretory, are entirely without foundation.
From the marks of inanition appearing in the system, it is demonstratively proved, that, from a variety of other means, a greater evacuation can be produced than from mercury. In such circumstances, however, by mercury the venereal disease is cured, by these other evacuants it is not. And farther, where the cure oflues venereahas been retarded by a salivation occurring early, or where no cure has taken place after salivation has been continued for a considerable time, there is every mark of a much higher degree of inanition than when the disease has been removed by mercury without any sensible evacuation. There can remain no doubt, then, that the cure oflues venereais by no means in proportion to the evacuation which it produces. This, however, should necessarilybe the case, were the cure effected by evacuation.
Upon the whole, then, from what has been said of this theory of the action of mercury in the cure of thelues venerea, it appears, that the cure can by no means be referred to the evacuation. The different arguments adduced in favour of that theory, we have endeavoured to shew, either proceed on wrong principles, or, although admitted in their greatest latitude, can afford no ground for any conclusion to support it. Evacuation, from its nature, whether supposed to operate by diminishing the quantity of circulating fluids, or by any change it can induce in their quality, can scarce be conceived to be a cause adequate to the cure oflues venerea. Evacuation does not produce a cure of thevenereal disease, when it takes place in an equal, or even in a much greater degree, from the employment of other medicines, than when the disease is effectually removed from the use of mercury. And,lastly, the venereal disease is never more effectually cured by mercury, than when it is evident, from every mark by which the degree of evacuation can be determined, that the evacuation arising from it is least considerable. It may, therefore, with confidence be asserted, that mercury does not curelues venereaby evacuation.