CHAP. VI.
Of the Mercurial Preparations intended to act in the cure ofLues Venereaby entering the System.
Anattempt has already been made to explain the operation of mercury, and the manner in which the venereal poison may be supposed to exist as a cause of disease. From these it might perhaps be concluded, that the introduction of mercury into the system was seldom requisite. And it might seem reasonable to infer, that all the advantage which could be obtained from mercury, might be had from its application in one or other of the ways already mentioned. So far,however, is this from being the case, that it is no uncommon thing with practitioners to inveigh, in the most express terms, against all external applications, those excepted which are of the mildest and most inactive nature. Mercurials have not been excluded, and the healing up of sores, by whatever external means it may be effected, has been considered as highly prejudicial.
It can by no means be asserted, that these accusations against the external use of mercury are entirely without foundation. If properly understood, however, they may be true, without being any objection to the theory. It can never be imagined, that, from the destruction of the venereal virus at a particular part, by any application made there, it should be destroyed in the rest of the system.When, therefore, the venereal virus has already been absorbed, a radical cure cannot be expected from the healing of an ulcer. It may even sometimes happen, that, from a partial destruction of the virus in an ulcer, it may be healed externally, and, at the same time, absorption more considerably promoted than if it had remained open.
From these circumstances it is easy to see, that, upon the theory formerly adopted, the introduction of mercury into the system is, in many cases, not only proper, but even necessary. But, at the same time, the advantages which, from that theory, we are led to expect from the immediate application of mercury to parts affected by the venereal virus are not less true.
As the first method of using mercurywas by external application, for an action on the parts affected; so external application was likewise the first means employed for introducing it into the system. For that purpose, all the various modes of applying mercury, which have already been mentioned, have, at different times, been used. Applications of mercury to the surface of the body by unction, plaster, fumigation, and lotion, have each, at different times, and by different practitioners, been recommended as the safest and most effectual method of introducing it into the system. But, after longer and more accurate observation than could at first be obtained, the application of mercury in the form of unction is the only method of introducing it into the system, by external application, which is now in practice.
Whatever may be the means used for introducing mercury into the system, it is certain, that, if it do enter it in an active state, it will cure the disease. Its introduction by unction is still by no means an uncommon practice. By several modern practitioners, this method of introducing it into the system is still recommended, as preferable to every other. When properly viewed, however, it must be allowed, that if it be attended with advantages on the one hand, it is by no means free from inconvenience on the other, and in certain circumstances only is a preferable practice.
In the mercurial ointment, the preparation which is here used, the mercury, as was formerly observed, is rendered active from division by triture. The mercurials prepared in this manner arein general the mildest in which mercury is in an active state. It may be laid down as an undoubted fact, without pretending in this place to assign any cause for it, that the milder mercurial preparations have a greater tendency to operate by salivation than the more acrid. But there is perhaps no method of exhibiting mercury in which it more certainly operates by salivation, than when it is applied externally in the way of unction.
After what has been said by the greatest authorities in medicine against salivation, it would be unnecessary to add any thing here. It may be sufficient to observe, that it has been pronounced to be a practice not only attended with very great inconvenience, and no inconsiderable danger, but even unnecessary. The tendency, therefore, which this modeof introducing mercury into the system has of exciting salivation, may be considered as no small objection to its being put in practice.
But, while it cannot be denied, that salivation is attended with many inconveniencies, it must at the same time be allowed, that the degree in which it takes place, is, in general, proportioned to the quantity of active mercury which enters the system. And it occurs chiefly in those cases where the medicine is not so acrid as to find an outlet by some other excretory. When, therefore, the disease has been of long standing, and obstinately rooted in the system, altho’ salivation may not be necessary for a cure, yet it will be the unavoidable consequence of the employment of that quantity of mercury which is requisite in thesystem for overcoming the disease. This mode of employing mercury, then, is not in every case to be rejected from the tendency which it has to excite salivation.
But, it may further be objected to this mode of employing mercury, that the quantity of active mercury, which in this way is introduced into the system, cannot be easily ascertained. And that, even before any obvious effect is produced, a much greater quantity may be thrown in, than is really necessary for a cure, from which troublesome consequences will afterwards ensue. These indeed are facts which cannot be denied; and it must even farther be allowed, that all the good effects in the cure oflues venerea, which can be obtained from this method of introducing mercury into the system, may be had from the internaluse of other preparations equally mild, and from which the patient is not exposed to the same inconveniences.
From these circumstances, it may be concluded, that the introduction of mercury into the system in the way of unction, is neither proper in slight cases, nor in the greatest number of obstinate ones. There are, however, constitutions in which mercury, in any form, is very apt to produce an immediate and violent action upon the alimentary canal. Sometimes it excites vomiting, but more frequently it induces looseness. In such constitutions, these effects do indeed often follow, even when the mercury is introduced by the absorbents on the skin. But they are more certainly the consequence of the immediate application of mercuryto the alimentary canal itself. Besides this, when these effects happen from the immediate application of mercury to the alimentary canal, the introduction of the medicine into the system, is often in a great measure, if not entirely, frustrated. And farther, the effects of mercury on the alimentary canal not only less certainly follows, from its introduction by the surface, than from immediate application, but may likewise be more easily obviated. In such circumstances, therefore, a cure of venereal complaints may, with greater certainty and ease, be affected, from the introduction of mercury by the surface in the form of unction than from any other mode of using it.
Perhaps the most common form of exhibiting mercury in this place, witha view of entering the system, is that of the mercurial pills. These, when properly prepared, seem, in most cases, to be justly entitled to the preference, which is here so frequently given them. The mercury, in this preparation, is rendered active by the same means, and is in the same state as in the preceeding one. Its operation likewise in this form is very analogous to what it is in the one formerly mentioned. It is here equally apt to salivate as in the form of unction. But the salivation induced by the mercurial pills very rarely arises to so high a degree, at least so suddenly, as from unction. The quantity of mercury introduced into the system in this form, admits of being more certainly ascertained than by unction. The principal ambiguity which takes place with regard to the pills, arises from the difference ofcare with which they are prepared, and the degree of solubility in the stomach which those substances possess with which the mercury is combined.
The mercurial pills affect the guts less than many other preparations of this metal. This indeed might be inferred from considering that the mercury is here in a very mild state.
From the use of mercurial pills, mercury may be introduced into the system in very considerable quantities. But, as in this form it is not readily discharged by the different emunctories, it is apt to be accumulated in a greater quantity than is requisite for slight cases. In these, therefore, the pills are not so advisable as some other preparations. But, where the alimentary canal can bear mercurywith ease, the mercurial pills are perhaps preferable to any other form, for those obstinate cases where it is requisite, that a considerable quantity of the medicine in an active state should be introduced into the system. And they are particularly proper in those cases which are only to be overcome by a gradual and long continued use of mercury.
To the forms of exhibiting mercury which have already been mentioned, those lately introduced by Mr Plenck of Vienna may properly be subjoined. Of the various preparations which he has proposed, what he seems chiefly to have used himself, and what has been principally employed here, is his simple mercurial solution. What is to be said, then, concerning his preparations, as they areall very similar in their nature, may be confined to this form.
This gummous solution is, in the table of mercurials, reduced to the same general head with the two preparations last treated of; the mercury in this case likewise being rendered active by division from triture. Although the use of this preparation is but a late proposal, yet, since its introduction, it has been a good deal employed, and the facts which may be had with regard to it cannot be alledged to be few. That general observations, however, may, with justice, be made, numerous facts are requisite; and perhaps what can as yet be had on this subject are still an insufficient foundation for any certain conclusions.
It may, however, with regard to thismedicine, be confidently asserted, that the opinions upon which its superior efficacy is founded are without foundation. It is a mistake to suppose, that any peculiar affinity, or specific elective attraction, takes place betwixt mercury and vegetable mucilage. And mercury with gum, as well as in other forms, if, from triture, it be rendered sufficiently active, and if it be introduced into the system in sufficient quantity, will also excite salivation. This preparation, then, is still to be considered as, in a great measure, on the same footing with the two others already mentioned.
But, united with vegetable mucilage, mercury seems to act less upon the intestines than the mercurial pill. This is probably to be referred to the viscidity of the substance with which themercury is here combined. Vegetable gum possesses a remarkable power of sheathing and defending those parts to which it is applied against acrimony of any kind.
This preparation, taken in what would seem an equal proportion with the mercurial pill, shows a less powerful action on the system, both in its effects on the excretions, and in its influence on the morbid symptoms. This diminution of action may perhaps, in some degree, be accounted for from the mercury being less readily absorbed into the system, after entering the alimentary canal, in consequence of the viscidity of the gum with which it is united. But as vegetable mucilage, when taken by itself, is observed to diminish the action of mercury, in whatever way it be introduced intothe system, this effect must be principally accounted for from some other cause. Probably it depends upon the influence of the mucilage, after having entered the system, in defending the excretories against the violence of the stimulus from the mercury.
This form may, upon the whole, be esteemed, although not a powerful, yet, in many cases, an useful preparation. It is chiefly preferable to other mercurials in those recent cases oflues venereawhere a weak preparation will answer the purpose; and where, at the same time, it seems most adviseable that the mercury should be slowly introduced into the system.
The three preparations of mercury which have already been treated of, whencompared with many others, may be esteemed mild. There are a different set, which, in opposition to these, may be termedacrid. Of the acrid preparations, not a few have likewise been used in the cure oflues venerea, and for this purpose introduced into the system in different forms. To treat of all of these would not only be deviating from our first intended plan, but would lead to many unnecessary repetitions, and needless inquiries, with regard to medicines which are now by no means in common use. Calomel and corrosive sublimate may be esteemed the two extremes of the acrid preparations; the first being the mildest, the last the most stimulant, which is, in the present practice, ever used internally. These two are, at the same time, the acrid preparations which are perhaps most frequently employed in the cure oflues venerea. To treat of these therefore will be sufficient.
Calomel, it has been observed, may be considered as the mildest of the saline preparations of mercury. In this preparation, the basis of which is the corrosive sublimate, the mercury is reduced to the form of a saline compound, by means of the muriatic acid. But it is afterwards rendered less acrid, from the addition of fresh mercury in repeated sublimations. It has by many been esteemed the most useful of the mercurial preparations, not less for other purposes for which mercury may be employed than for the cure of the venereal disease. The good effects which may be obtained from its use in this complaint are confirmed by undoubted experience. And, when it is introducedinto the system, there can be no question with regard to its efficacy in destroying the venereal virus.
Calomel acts as a more general stimulant in the system than the milder preparations of mercury. And it discharges itself by the different excretories, when present in the mass of circulating fluids, in no very considerable quantity. Hence, it can be less accumulated in the system than the other preparations formerly mentioned. To this circumstance it is probably owing, that it less frequently excites salivation than these do. If, indeed, it be given in large doses frequently repeated, and does not at the same time affect the intestinal canal, it will excite salivation. From this, it may be concluded, that then the active mercury is present in thesystem in a very considerable quantity. But, when in this way, even such an accumulation can be obtained, it is to be considered only as on the same footing with the milder mercurial preparations, in those constitutions which are readily salivated. Here, therefore, as in habits naturally disposed to salivation, the presence of any quantity of mercury in the system will be very transient, and a salivation occurring will often frustrate the cure to be expected from it.
Calomel, from its general stimulant power, may readily be supposed to affect the intestines more considerably than the milder mercurial preparations; and, in fact, it is found, that, in many cases, it much more readily excites looseness than they do. From this circumstance, it can be less easily introduced into the system,especially if the alimentary canal possess uncommon irritability.
If these assertions with regard to this mercurial preparation be well founded, it will be easy to determine in what cases calomel is preferable to other mercurials, and in what it is to be considered as less proper. It cannot be considered as well adapted for those inveterate and obstinate cases in which a long and gradual use of mercury is requisite, and to overcome which it is necessary that a considerable quantity of mercury should be accumulated in the circulating system. On the other hand, if the intestines are not very irritable, it will be particularly serviceable, in many recent cases, in which a speedy action of mercury is adviseable; and, in those where the venereal virus has not yet made its way intothe circulating system, but is detained in the lymphatic, or in the mucous glands. From its sudden evacuant power, it may likewise be of great service where mercurials in the venereal disease are intended to be conjoined with an antiphlogistic course, or to make a part of it.
What has been said of calomel may be considered as sufficient, with regard to the milder part of the saline preparations. It now only remains, then, that some observations should be offered on corrosive sublimate, which is the most acrid of these that is usually employed internally.
Corrosive sublimate, it has already been observed, is the basis of the preparation last treated of. But, in this preparation, the mercury, from the proportionof muriatic acid which is united with it, is in a very acrid state. When taken in substance, even in a very inconsiderable quantity, it proves a virulent poison to the human frame. To this circumstance it was probably owing, that, for a very long time, it was used only for external purposes, and even then, from its high stimulant power, not without the greatest caution. But the many inconveniencies attending salivation, which was at the same time found to be by no means absolutely necessary to a cure, induced practitioners to make trial of preparations less apt to have that effect, than those which had formerly been used. As every preparation of mercury, in proportion to its acrimony, has a greater tendency to act upon the surface, and less to affect the salivary glands, it is notsurprising that corrosive sublimate should at length have been proposed.
The violence with which corrosive sublimate acts, has always been a sufficient reason to prevent its being thrown in, either in large quantities, or in substance. Of late years, however, a weak solution in ardent spirits has been recommended as an efficacious remedy, and often used with success. But, as it has been found that the mercury is apt to precipitate from this menstruum, if the solution is kept for any time, water has often been substituted to the spirits. Water is perhaps, in every case, even by itself, a better menstruum than spirits; but, besides this, it may be much improved, from having its solvent power increased by the addition of sal ammoniac. Bythis means, the precipitation of the mercury may be, in a great measure, if not totally, prevented.
Corrosive sublimate, when introduced into the system, is, as well as calomel, very universally stimulant. But its chief tendency, unless prevented by some accident, is to operate upon the surface. For the most part, it powerfully excites diaphoresis, and in this way is speedily evacuated from the system. But, if there is in the patient’s constitution a want of disposition to diaphoresis, or if the discharge by the surface is suddenly checked by the application of cold, it frequently acts upon the salivary glands, inducing salivation.
From the success with which the useof corrosive sublimate has been attended, it cannot be doubted that it is highly active in destroying the venereal virus. And, either from the circumstance of its entering the system more readily, or from its greater activity, it produces an equal effect, in the cure oflues venerea, to what arises from most other mercurials, even when it is employed in a less considerable quantity.
This preparation, in proportion to its superior acrimony, is more apt to affect the bowels than any of the other mercurials already treated of. This circumstance is, in many cases, an unsurmountable objection to its use. From its high stimulant power, it can never be lodged in the system in any considerable quantity. Notwithstanding its activity, therefore,it is not well fitted to eradicate obstinate complaints. From its influence upon the alimentary canal, its use cannot with safety be continued for any considerable length of time. It is not, therefore, well adapted for those cases which require a long and gradual use of mercury.
As this is a form in which a quantity of very active mercury may suddenly be introduced into the body, it may be supposed well adapted for producing some alleviation in urgent symptoms. From the tendency it has to act upon the surface of the body, it may be presumed to be a preparation of great utility against cutaneous affections from a venereal cause. If recourse is had to the examination of facts, it will be found,that the conclusion, which would here be drawn from reasoning, is confirmed by experience; and that, in reality, the solution of corrosive sublimate may be employed with peculiar advantage in both these cases.
Thus much with regard to calomel and corrosive sublimate. Many other preparations, of an intermediate degree of acrimony between these, such, for example, as themercurius calcinatus, are likewise in common use. But the cases to which we would be inclined to suppose these best adapted, may easily be learned from what has been said of the two extremes.