CHAP. V.
Of the Mercurial Preparations intended to act immediately on the Parts affected withLues Venerea.
Everypreparation of mercury may perhaps, under proper management, be successfully employed in the cure of the venereal disease. But by much the greatest number of these preparations neither are, nor ever have been, in common use for that purpose. To treat, at any considerable length, of all that are at present in use, would lead to prolixity and repetition. A few observations on those which, from their being most successful, are at present most frequently employed, will afford sufficientdata for determining the choice of one preparation in preference to another.
The different modes in which mercury has been exhibited have very universally been reduced to two general heads, and referred either to its employment externally or internally. This division, however, is not without some degree of inaccuracy. Mercury, when taken internally, is very universally thrown into the system in general, without any particular attention to the affected part. When it is used externally, it is for the most part meant to act immediately on the diseased part. This, however, is not always the case; and sometimes the only thing intended by external application is its introduction into the system. But, when this is the case, its external employment is on precisely the same footing with its internaluse. The proper distinction, then, depends not so much upon its being used either externally, or taken by the mouth, as upon the mode in which it is meant to act. Mercury, in every case, is intended either to act immediately upon the affected part, or to enter the circulating system.
If there be any truth in what has been said with regard to the action of mercury, the manner in which, in each of these ways, it comes to produce a cure, can readily be conceived, and is, at bottom, very similar. But, at the same time, these different modes of using the medicine are, in some measure, fitted for different purposes; and the influence which is exerted in the one way demands attention, which is not always requisite in the other. These methods of using mercury,then, may, with greater advantage, be considered separately than together. And what would claim consideration, in the first place, are those modes of application, in which the mercury is intended to act immediately upon the affected part.
From the opinion which was long entertained, that mercury, in every form, was a substance highly poisonous, it is not surprising, that, upon its first introduction into medicine, it should have been used externally only. In this way it seems also to have been first employed in the venereal disease. But, from the tendency which mercury has to enter the system, when used in any form, it is not surprising that its effects, as exciting salivation, should soon have appeared from its use externally. To a salivation thusexcited, it was but natural to attribute the cure. Hence, from its external employment on its first introduction, there are few clear instances of its efficacy as acting immediately upon the venereal virus.
It is not, however, improbable, that, even in these early periods, some part of the influence which mercury had in the cure oflues venereawas to be ascribed to an immediate action on the venereal matter. In this way the good effects, in many cases, reaped from fomentations of cinnabar, one of the modes of applying mercury first put in practice, were certainly, in some measure, to be accounted for. It may, then, be affirmed, that the use of mercury, so as to act immediately upon the affected part, is a mode of applying it as early as its first introduction in the venereal disease. And,from examining the history of this distemper, as well as the various means which have, at different times, been employed in the cure, it will appear, that the immediate action of mercury on parts affected bylues venerea, particularly in places most easily reached, such, for example, as chancres, has always been a common intention in practice.
But enough has perhaps been said concerning the history of the immediate application of mercury. The present inquiry is with regard to the preparations now employed in this way, and the comparative advantage of each.
Among the first, and perhaps the most common forms in which mercury has been, and still is applied, with a view of acting immediately upon the affected part, are the mercurial ointments, cerates,and plasters. In this, as will appear from the table which has been given, the mercury is rendered active by division. Little difference can arise from the substance with which the mercury is combined during the triture. All these preparations, therefore, may, with propriety, be considered together. To this head may be referred, the blue ointments, mercurial cerate, and common plaster with mercury, of the London College; and the mercurial ointment, and plaster, of the Edinburgh.
These preparations seem to contain a very large proportion of mercury; and certainly, in their composition, a considerable quantity is blended. But it by no means follows, that the whole of that quantity is in an active state, or is in such a condition as to be capable ofan union with the venereal virus. From late observations, it appears, that by much the greatest part of the mercury, although here rendered invisible, is still in its crude state. The effect, therefore, to be expected from them is by no means to be judged of from the quantity of mercury which has been employed in making them. And they are in reality much weaker preparations than might be imagined.
These are often employed as dressings to open sores. But the oily nature of the substances with which the mercury is here conjoined, prevents it from admitting of a ready union with the venereal virus. On this account, their power will be still farther diminished than from the cause formerly mentioned. Hence it may be concluded, that they are not themost proper mercurial applications for open ulcers. And indeed an examination of the state of the fact confirms this conjecture. For, upon inquiry, it will be found, that in such circumstances greater benefit may be reaped from other mercurial applications.
Mercury is often meant to act in the venereal disease, without any general affection of the system, or without entering the mass of circulating fluids, where it cannot come into immediate contact with the affected parts. These parts are often deep seated, and, at the same time, the integuments above them are unbroken. In such cases, mercury, applied in a form capable of penetrating, or of being absorbed, promises to be of service. That mercury, in the forms here mentioned, is in this situation,cannot be denied. And, in such cases, these forms have the peculiar advantage, which many others want, of admitting of an easy, gradual, and long continued application. Hence it is, that singular benefit is obtained from them in the resolution of nodes and buboes.
It may not be improper here to observe, that, for these intentions, particularly the last, which is an affection of the lymphatic glands, it is a very effectual mode of using the mercury, to apply it in the form of unction to those places from which the lymphatic vessels passing through the diseased gland take their rise. In this way, equal if not greater benefit will, in general, be reaped, than from immediately applying it to the tumor itself. By this means, the mercury will be carried with more certainty,and in greater quantity, to the affected gland, than it would be from pervading the substance of the integuments.
Another form in which mercury was very antiently used, and still continues to be applied with an intention of acting immediately upon affected parts, is, its being reduced into a state of vapour, by which means it acquires a very high degree of activity. This mode of applying mercury is attended with many inconveniencies, and, in this form, its application, while it is very sudden, can at best be but temporary. It must, however, be allowed, that the active form which the mercury here assumes is a very subtile one. By this means, it becomes capable of penetrating and resolving hard and indurated tumors, which cannot be pervaded by mercury in otherforms. On this account, in such tumors, especially if they have been of long standing, and in obstinate ulcers which have resisted other mercurial preparations, the form of vapour may often be tried with peculiar advantage. For this purpose, cinnabar has commonly been employed. From its being resolved into fume, the mercury and sulphur are disunited, and the activity of the medicine totally depends upon the former arising in a state of vapour.
Mercury, in whatever way it is used, is most active in these forms in which, from the addition of acids, it is reduced to a saline state. Some of these are in their nature so extremely corrosive, that they can scarcely, with safety, be used even as external applications. This peculiarly holds of those preparationswhich are formed by a combination of mercury with the nitrous acid. That they may be fitted for use, therefore, various means are employed to render them milder. Among other methods, one frequently practised, is, the abstraction of acids by calcination. In this manner are prepared themercurius corrosivus ruberof the London college, and thepraecipitatus ruberorcalcinatusof the Edinburgh. These are forms of employing mercury which are every day in use, for application to the part immediately affected.
These preparations, even after having their action in this manner diminished, still possess a very considerable degree of corrosive power. On this account, they become particularly useful in many cases of venereal complaints,where corrosives are required. And hence it is easy to learn the foundation for the frequent and advantageous employment of these preparations in cases of fungous edged ulcers, of warts, and other such tumors.
That these preparations may be applied more commodiously, they are frequently mixed with different ointments, particularly with basilicon; but, by this means, their power of action is greatly diminished. Where it is intended they should act as escharotics, it is perhaps in every case most proper to employ them in the form of dry powders. Such dressings may then be applied above them as are best fitted to the nature of the complaint.
It may naturally be imagined, that,from mercury in this form, not only an escharotic power can be obtained, but that likewise, from its action as an antidote against the venereal virus, parts kept ulcerated, from the activity of this poison, may be healed. That, in some degree, it is fitted for this purpose likewise, is not to be doubted. But, to its employment in this way, its corrosive power is often an objection. In many cases, where it is required that an ulcer should be healed, a destruction of solid parts would be highly prejudicial. And when, in order to avoid this, the corrosive power of the mercury is diminished, from its being united with an ointment, the precipitate becomes liable to the same objection which was formerly urged against the efficacy of mercurial ointment. It is then in a state which does not admit of a ready union with the venerealvirus. It may therefore, upon the whole, be concluded, that mercury in this form is principally useful in those cases, where, with the effect of an antidote against the venereal virus, it is necessary to conjoin an escharotic power.
Mercury may be rendered saline by being united with other acids as well as the nitrous. These likewise are, in general, active preparations; but they do not possess a caustic power, at least in so high a degree as the nitrous preparations. Among the most active of the other saline preparations, are those prepared with the muriatic acid, and especially the corrosive sublimate. This is a mercurial preparation which, in many cases, may be employed to act immediately on parts affected by the venereal virus; it falls,therefore, to be considered also under this head.
The stimulant power of corrosive sublimate is so great that it is never, even for external purposes, used in a solid form. But theaqua phagedænicaof the Edinburgh College, which is a solution of it in lime-water, is a mercurial preparation which has often been used externally, both in venereal and other foul ulcers. This form, however, contains so large a proportion of the mercury, that it is by much too stimulant for the greatest part of sores. A more dilute solution, in common spring-water, is free from this inconvenience, while, at the same time, it serves every purpose which can be expected from the other.
The mercury in this solution is ina state sufficiently active to destroy the venereal virus, and is, at the same time, in a condition which will admit of a ready union with it. Good effects, therefore, might naturally be expected from it, especially as the form is such that it can with ease be applied.
The efficacy of this preparation has not indeed, as far as I know, been confirmed by long or extensive practice. But, where it is proper to heal superficial ulcers, no application is of greater service than dressings of lint dipt in a solution of the corrosive sublimate in the proportion of half a grain to an ounce of water. The addition of a small quantity of compound spirit of lavender to this solution will give it a colour and smell different from those of common water, which, withsome patients, are necessary conditions to an effectual application. In some circumstances already mentioned, the other modes of applying mercury to act immediately upon the diseased part may be preferable to this. But, where the only requisite to the healing of an ulcer is the destruction of that venereal virus at the part which supports a diseased state there, no application will answer the purpose with greater facility, safety, and expedition, than this solution.