CHAP. VII.
Of the Cautions to be observed in the Employment of Mercury inLues Venerea.
Fewmedicines, from which any considerable advantages can be obtained in the cure of diseases, are of such a nature that they can, in every circumstance, be exhibited without any inconveniency. On the contrary, the greater activity any medicine possesses, the more reason there is to apprehend disagreeable accidents from its being improperly used. When active medicines, therefore, are employed, it becomes, in every case, an object of particular attention, while we endeavour to obtain all the good effects which may be derived from them, to avoid thosebad consequences which they are most apt to induce.
These ends are to be obtained only by careful attention to many circumstances. Of the accidents most to be guarded against, not a few are, in a great measure, the natural consequence of the medicine itself. Although, in some constitutions, and with particular treatment, they will arise more readily than in others; yet they may happen in any constitution, and with any treatment. As occurring, therefore, most generally, they deservedly claim to be first considered.
It has already been observed, that every medicine, in proportion to its activity, is more apt to be followed by consequences not always to be wished for. Itmay therefore be laid down as a general rule, that active medicines should be employed only in cases where they are absolutely requisite. If this rule is proper with regard to any medicine, it must be so of mercury.
It is however but too true, that mercury is frequently employed in cases where its use might readily be dispensed with. And this holds not more of its employment in other diseases, than in some venereal complaints. When, indeed, the venereal virus has actually entered the system, perhaps a cure, by means of mercury, is in every case at least to be attempted. And a cure without it, by any medicine at present in use, is seldom, if ever, to be depended on. But, where the matter occasioning the affection is still in a state of topical application only,as happens in the case of gonorrhoea, the introduction of mercury into the system is totally unnecessary. And a cure may be effected by other means, not only with greater safety and ease, but likewise with more expedition.
Mercury, in an active state, when introduced into the system, has, in every case, more or less a tendency to affect the intestines. This action, while it seldom co-operates with its other effects in curing the disease, frequently produces the most mischievous consequences in the constitution. When it occurs, therefore, it is but natural to think of checking it. This may often be successfully done, by the employment of means fitted to promote a determination to the surface. Where this method fails, it may frequentlybe obviated, by giving opium at the same time with the mercurial.
Another consequence which often arises from active mercury, when introduced into the system in any considerable quantity, is its exciting salivation. This discharge is attended with numberless inconveniencies, and it is at the same time no farther necessary to a cure, than as it is a proof of the quantity of active mercury which is in the system. But, where mercury in the greatest quantity is requisite to a cure, to keep the patient upon the verge of a salivation is all that is necessary. Salivation, then, on its first appearance, is always to be restrained. For this purpose, it is necessary, that the use of the medicine should for a little be intermitted. Where that is insufficient, determinationto the surface, by means of diluent diaphoretics, has a tendency to restrain this discharge as well as the former, and may often, for this purpose, be used with advantage. But, in general, salivation will be most successfully checked, by increasing the determination to the intestines by means of cooling purgatives.
As well as other discharges, that by sweat may likewise, from the use of mercurials, take place in a degree not to be wished for. Although this discharge is attended with much less inconvenience than either of the two already mentioned, yet it may often be proper to restrain it. This may be done by keeping the patient more thinly clothed, and in a cooler temperature than before, and by a cautious exposure to open air.
The accidents already enumerated are the most common ones which can be considered as depending on the nature of the medicine itself. But, besides these, a variety of others, although less frequently occurring, might likewise be referred to this source. Independent of that affection of the gums and mouth, which, for the most part, is the forerunner of salivation, it sometimes happens, even where no particular exposure to cold can be blamed as a cause, that the whole head is remarkably swelled. Where this takes place, it is in general the consequence of throwing in the mercury too suddenly, and may best be avoided by a more sparing and gradual use of the medicine.
From continuing the use of mercury for a considerable time, in some cases,febrile complaints will arise. These, if they admit of a cure, while the use of the mercury is continued, will most readily be overcome by the means commonly employed for the relief of hectic fever. But it seldom happens, that these symptoms can be removed without omitting the use of the mercury. In such cases, therefore, even although from the remaining appearance of a venereal taint, the farther continuance of mercury would seem adviseable, yet, when these febrile symptoms supervene, it is for the most part necessary, to trust the cure to other means.
The action of every medicine, and consequently the circumstances claiming attention in its employment, are considerably varied by peculiarities in the habit in which it is given. What, in thisrespect, therefore, is chiefly to be attended to in the use of mercury, falls next to be considered.
Although it has been observed, that the accidents already mentioned may happen in any habit; yet it is certain, that in some particular habits, they will much more readily take place than in others. Where constitutions, therefore, naturally exposed to these accidents do occur, it is necessary, that the means to be employed for preventing the inconveniencies which would arise from thence, should be had recourse to, more early than in patients of a different constitution.
Mercury, when introduced into the system, has always a tendency to produce evacuation. At particular periods oflife, evacuation is less easily born than at others. Hence, the long continued use of this medicine, or its employment in a considerable quantity, are always particularly to be avoided with people much advanced in life, or with infants.
During infancy, mercury may likewise produce inconvenience, from its stimulant power. On this account, the more acrid preparations are, during that period of life, to be avoided. If, however, their use should be esteemed necessary, they are to be employed only in small doses.
Stimulants are not more dangerous in irritable habits than they are in plethoric ones; or in those in whom the force of the circulating fluids is very great. On this account, with patients inthe vigour of life, evacuation is often requisite previous to the use of mercury.
These observations suggested by the age of patients using mercury, would naturally lead to the consideration of such as result from sex. From the laws of the male system, few, if any directions which will not fall under other heads, are peculiar to men; but, in the female œconomy, there are many circumstances which require particular notice.
Mercury promotes menstruation, and is apt to produce it in an excessive degree. On this account, it is always proper to intermit its use for some time previous to the flow of the menses, and during the continuance of this discharge. From the influence it has uponthis evacuation, its use to any considerable degree during the term of pregnancy, is totally inadmissible. When mercury is used during nursing, it has such an effect upon the milk, that a child suckled by a woman who takes it, may by that means be cured of the venereal disease.
In different diseases, where the child is healthful, the influence of mercury on the milk would be an objection to its use, during nursing, for any particular complaints of the woman. But, where a nurse labours under the venereal disease, since in this situation she can never be supposed to suckle a child not likewise infected, as the remedy is equally necessary for both, there is no reason for delaying to attempt a cure during that period.
The different temperaments of patients, as far as they are marked by obvious signs, and have been distinguished by medical writers, afford little ground for particular observations with regard to the use of mercury. What has been said with regard to the prime of life, holds more especially with those of a sanguine habit; and the observation made concerning old age, in some degree, applies to the melancholic. But, with all temperaments, mercurials may in general be used without any peculiar preparation; and, during their use in such cases, no particular cautions are necessary which will not be suggested by other circumstances.
But, although it is necessary to say little with regard to temperaments obviously distinguishable; yet it is well known,that very great varieties in the operation of mercury arise from peculiarities in constitution. And this happens where there are no particular marks indicating such a singularity. Some constitutions are affected by mercury with very great ease, whether as acting on the alimentary canal, or as entering the system, and exerting its effects there. In cases, therefore, where the constitution of the patient is not previously known, some degree of preference is, on this account, due to the mildest forms. And, in those cases for which the more acrid ones seem best fitted, it is necessary to begin with the employment of small doses; and, if the action of these shall be found to be too violent, to have recourse to the different means of taking off sensibility. The most immediate, and perhaps the most effectual, means of removing or diminishingsensibility, is by the use of opium. But the same end may, in many cases, be obtained with equal ease, and less hazard, from the use of emollient and mild diluents; such as decoctions and emulsions, abounding with vegetable mucilage.
While some constitutions are easily affected by mercury, others, on the contrary, are acted upon with difficulty only. With these last, after the use of even a very considerable quantity of mercury, little, or perhaps no obvious action on the system can be observed. This is to be ascribed to one of two causes; either it arises from the mercury’s never having entered the system; or from its being accumulated there without proving a stimulus to any secretion. In the latter of these cases, all the effects wantedfrom the use of mercury may be obtained with greater ease than in any other.
The only thing, then, which is necessary in such cases is to proceed with caution, and not to throw into the system an unnecessary quantity of mercury, by which the patient may be exposed to those inconveniencies which, in a greater or less degree, accompany every increased excretion.
But it is not always an easy matter to distinguish betwixt this and the case first mentioned, in which it was alledged, that the want of obvious action arose from the mercury’s not having entered the system. When this happens, a gradual and slow procedure would not only be losing time to the patient, but allowing the disease to gain ground. Theonly certain mark for distinguishing betwixt these two cases, is the change produced in the morbid symptoms. In the one, the disease remains either unaltered or increased; in the other, all the symptoms are manifestly changed for the better.
If, from this test, it appear, that the want of obvious action after the use of mercury proceeds from its not having entered the system, a very different treatment is necessary from what was proposed in the former case. Here it is requisite, without loss of time, to have recourse either to a different preparation of mercury from what was formerly used, or to a different method of introducing the medicine.
The circumstances already mentionedas claiming attention, regard peculiarities of constitution where no other disease exceptlues venereacan properly be said to exist. But it often happens, that the venereal disease exists in patients who are, at the same time, affected with other complaints. This affords a very extensive field for particulars to be attended to in the employment of mercury. To treat of the variety of diseases which may, in any degree, be affected by it, would be an almost endless task. In some, the mercury will be of service, as tending to a cure; many others, on the contrary, are by its use rendered evidently worse. Its influence in aggravating complaints has been said to hold, among a variety of other diseases, in cases of epilepsy, gout, and rheumatism. But on this subject attention is chiefly requisite to scurvy and hæmoptoe.
In scurvy, mercury very generally occasions a quicker progress of all the complaints. Hence, when, in such circumstances, it easily can be avoided, it is a medicine never to be employed. Cases, however, will occur, in which, although scurvy actually does exist, the use of mercury will be adviseable. In such cases, if the mercury is used slowly and cautiously, a cure of the venereal symptoms may be obtained, without rendering the scorbutic complaints much worse; but, if the mercury be suddenly thrown in, disagreeable symptoms will often arise. Of these, the principal are fœtid gangrenous ulcers, affecting the inside of the cheeks, the tongue, the palate, or the gums. It may farther be observed, that, although these are in general the consequences of the imprudent use of mercury; yet they will sometimes arise whereit has been used even with the greatest caution. When they do happen, let their cause be what it will, there is, in every case, so much danger as to make it necessary to discontinue the use of mercury. Recourse is then first to be had to the employment of such means as are best calculated for the removal of scurvy. If this can once be effected, the removal of the venereal complaints may be attempted, either by the employment of other means of cure, or even by resuming the use of mercury.
Another complaint, which may be complicated with the venereal disease, and during the existence of which particular caution is necessary in the use of mercury, is hæmoptoe. That habit of body which particularly disposes to hæmoptoe is well known, and, even wherethe disease has never existed, can be detected by obvious marks. Many patients, after having been once attacked with hæmoptoe, are seemingly cured, and have every appearance of being restored to perfect health. Both these situations may be considered as, in a great measure, the same: In either, hæmoptoe will be induced from very trifling causes. Among others, the use of mercury has frequently been observed to have this effect. In all such cases, then, it is necessary that mercury should be used in small doses, and introduced slowly into the system.
Notwithstanding every precaution, it sometimes will happen, that hæmoptoe will arise from the use of mercury. When this is the case, it is necessary not only to abstain from the useof the medicine, but to have recourse to those means which are found to be most effectual in the cure of so dangerous a symptom. For this purpose, bleeding, refrigerants, and astringents, must be employed, as the circumstances of the patient direct. While the hæmoptoe continues, the use of mercury is not to be attempted. And although, by these means, it should happen to be removed, this medicine, unless in cases where the venereal symptoms are very urgent, is not to be ventured upon for some time, even in the most gentle forms.
We have now pointed out the principal circumstances claiming attention in the employment of mercurials, which depend either on the nature of the medicine itself, or on the condition of the patient in whom it is employed. It now onlyremains, then, to offer some observations with regard to the necessary regimen. What is to be said on this subject will respect either diet, temperature, or exercise; each of which may be considered in order.
It has been alledged, that mercury operates in the cure oflues venereaby acting as an antidote to the virus which produces the disease. If this is the case, it is difficult to see how any particular diet can have the least tendency to promote its operation. In adapting the diet to the medicine, then, the principal thing to be attended to, in this case, is, to order such a one as will most readily counteract those accidents which the medicine is apt to induce. The accidents chiefly to be guarded against, from the use of mercury, are those arising from its stimulantpower. In diet, therefore, it is in the first place requisite, that every thing stimulant should be avoided. And then, if it can be done, such substances are to be employed as, when taken into the system, have a tendency to counteract a stimulus.
From these general principles, it is easy to see what diet is in this case to be recommended. The use of butcher-meat, and indeed of animal food in general, of wine, and of spirits of all kinds, are, from their stimulant quality, if not to be totally forbid, at least to be used sparingly. Food of every kind much salted, or highly seasoned, is to be discharged. And all such substances as would act upon the mercury, while yet in the stomach, are particularly to be avoided. The diet should be of the mildest andblandest nature, consisting chiefly of farinaceous, and mucilaginous vegetables, and of milk. The drink should be such as will quench thirst and dilute, if at the same time the patient will take what will act likewise as a demulcent, it is often preferable to such fluids as will answer only the two first intentions. For these purposes, water with toast, milk and water, barley-water, mucilaginous emulsions, or the like, may be employed with advantage.
The diet here pointed out as most suited to the nature of the medicine, is likewise best adapted to that of the complaint. As the venereal disease depends upon the introduction of a peculiar virulent matter into the system, it will scarce be imagined, that any species of diet can have great influence inthe cure. But, when it is considered, that the manner in which this matter acts, is, in the first instance, by exciting inflammation, it may readily be conceived, that, from a particular diet, its action may be rendered less violent than it would be otherwise. As, for this purpose, the antiphlogistic regimen is unquestionably the most proper, it is only necessary to add to what has already been observed, that the diet above recommended should be used sparingly.
It has very universally been esteemed necessary, that those who use mercury should be kept in a warm temperature. And it is an undoubted fact, that no medicine renders the body more susceptible of injury from cold than mercury. In consequence of a sudden exposure tocold during the use of this medicine, the most fatal accidents have been observed to arise. He therefore who has taken mercury cannot be too cautious in guarding against this extreme.
But, to avoid the inconvenience which may be produced by cold, there is no necessity for running into the opposite extreme. Confinement to a very warm chamber, and the use of a number of flannels, produce a temperature which, although not so dangerous as cold, is equally improper. The cure oflues venerea, if not frustrated by the discharges thus promoted, is often retarded, and less easily obtained than it would otherwise be. After a patient has for some time been kept warm, a sudden exposure to cold is hurtful, becausethe parts are unable to bear the stimulus which it occasions. The same effect does not follow upon a change from a cold to a hot temperature, not only because this is seldom so sudden, but because it likewise promotes many different evacuations.
There appears then an evident cause why the one extreme is more dangerous than the other. But the inconvenience from either is a sufficient objection to it. What is required of temperature during the use of mercury, is, that it be such as to support a proper balance betwixt the different excretions. To obtain this, a temperature inclining to neither extreme is in general the most proper. When, however, there appears in the constitution a peculiar disposition to the augmentationof any excretion, the temperature in which the patient is kept should incline to the extreme least apt to encourage it.
From what has been said of temperature, it will appear, that it is not necessary in every case, and at every season of the year, that those who take mercury should be confined to a chamber. But, when the circumstances are such as to admit of a patient’s going abroad, all violent exercise is to be avoided. From violent exercise, the patient is liable to the same inconveniencies as from a hot temperature, and frequently to all the dangers resulting from a sudden exposure to cold. Of exercise, as of temperature, it may be observed, that it should be so regulated, as to support a properbalance among the different excretions. For this purpose, when the patient is abroad, moderate exercise is in general requisite. For the same reason also, even when the patient is confined to his chamber, such moderate exercise as can there be obtained, is for the most part proper.
FINIS.
FINIS.
FINIS.
Lately Published,By the sameAUTHOR,In one Volume,Octavo,Pricein Boards, 4sh.ELEMENTSOFTHERAPEUTICS.
Lately Published,By the sameAUTHOR,In one Volume,Octavo,Pricein Boards, 4sh.ELEMENTSOFTHERAPEUTICS.
Lately Published,
By the sameAUTHOR,
In one Volume,Octavo,
Pricein Boards, 4sh.
ELEMENTS
OF
THERAPEUTICS.
IN this Treatise, the Author endeavours to point out the means by which the different classes of medicines operate in the cure of diseases; the indications they are fitted to fulfil; the cautions to be observed in their employment; and the morbid conditions forbidding their use.
Transcriber’s Notes:Missing or obscured punctuation was silently corrected.Typographical errors were silently corrected.Inconsistent spelling and hyphenation were made consistent only when a predominant form was found in this book.