_Concerning the Opinion, that Mercury cures Lues Venerea, by acting as
an Antidote to the Venereal Matter._
IT is an undoubted fact, that mercury, by proper management, cures _lues
venerea_. From the arguments already adduced, it has been concluded,
that the cure, thus obtained, is not the consequence of evacuation.
Having rejected this prevalent opinion, then, it next remains to say, in
what manner a cure is produced.
It has long been an opinion, very generally received, that mercury is a
substance capable of destroying the venereal virus; or that, from being
united with this virus, possesses a power of rendering it inactive. Many
arguments tend to prove, that this is in reality the case; and that in
this manner it cures _lues venerea_. But, at the same time, this theory
is not to be considered as without difficulties. The first that occurs,
is, with regard to the mode in which an opportunity is afforded for a
mixture of the mercury with the virus.
It is, in general, imagined, that mercury may destroy the venereal virus
in the mass of circulating fluids. The venereal virus is unquestionably
taken into the human system by the absorbent vessels to which it is
applied; and, before it can reach various parts of the body, in which it
evidently manifests itself, it must enter the general mass of fluids. We
cannot, then, consider it as a supposition totally absurd, that mercury,
if it be capable of destroying the activity of the venereal matter, may
produce that effect while the virus is present in the general mass of
fluids. Many objections, however, may be urged against this supposition;
and, if it be adopted, it must be allowed to be with difficulties.
If mercury destroy the venereal virus, while it exists in the mass of
circulating fluids, it must produce this effect, either by an alteration
of the general mass; or by acting more particularly on the venereal
matter itself. The whole mass of circulating fluids, taken collectively,
is a very considerable quantity of matter. The action, therefore, of a
small proportion of mercury, as producing any change upon it, cannot be
very great. It is not easy to conceive, then, how a destruction of the
venereal virus should arise from any alteration which the mercury is
capable of producing on the general mass.
The difficulty occurring to the first supposition here made, would
naturally lead us to consider the second. But that the action of
mercury, while it exists in the mass of circulating fluids, should be
exerted on the venereal virus alone, is a supposition equally
unsatisfactory as the former. Before this can be imagined to be the
case, it is necessary to suppose, that there exists, between mercury and
the venereal virus, some particular attraction. Such an attraction,
however, is a thing as yet by no ways proved to exist; nor indeed does
there seem to be any shadow of reason to suppose that it does exist.
Although, then, it cannot be denied, that mercury and the venereal virus
may exist in the mass of circulating fluids at the same time; yet, from
what has been said, the supposition, that the activity of the virus is
then destroyed, will appear to be attended with many difficulties. It
cannot, it is true, be alledged, that, from any thing which has been
urged, this supposition is refuted. That it may perhaps, in some degree,
act in this way, is by no means impossible. But it is to be remembered
that this is a hypothesis supported by no proof; and the more imaginary
any opinion is, the less easily can it be overturned. The present
opinion, then, may be set aside, for reasons, which, in other respects,
would be insufficient for its being rejected; and this the more readily,
if another and more probable hypothesis can be advanced which is not
liable to the same objections.
To determine the manner in which mercury acts on the venereal virus, it
might seem requisite that the nature of this poison should first be
ascertained. In what the activity of the venereal virus consists, it is
difficult, perhaps impossible, to say. Various conjectures have indeed
been offered with regard to it. But what has hitherto been advanced upon
that subject is so hypothetical as scarce to deserve a serious
refutation. What could, therefore, be derived from an inquiry of this
nature, without a more perfect knowledge of the subject than has
hitherto been attained, would be but of little utility.
But, although the peculiar nature of the venereal virus, and those
principles in consequence of which it becomes active, are unknown, yet
its general effects, as acting on different parts of the human body, are
sufficiently obvious. The parts morbidly affected by the venereal virus,
at different times, put on different appearances. This, however, is in
common to all of them, that, when reduced to the state of an open ulcer,
they discharge an infectious matter capable of propagating the disease.
It cannot therefore be doubted, that the venereal matter occasions the
morbid affections there observed from its actual existence at these
places.
As the places evidently affected by the venereal poison are frequently
very distant from those to which the poison has been first applied, and
do not lie in the course of the absorbents, it can only be carried to
them in the course of circulation. But, even while the poison is present
in the circulating system, no change can be detected on the general mass
of fluids; nor in by much the greater part of the solids in the body.
Many changes may take place in the fluids of the human body which cannot
be said to constitute a diseased state. That such changes may be
esteemed morbid, it is necessary that they should manifest themselves
over the system in general. If, then, we are to judge by these
principles, it follows, that the venereal poison does not produce a
morbid state in the general mass of fluids. It evidently acts as a cause
of disease in particular parts, whether it first comes to be applied to
these by immediate contact with external objects, or arrives at them in
the course of circulation. Probably it acts as a morbid cause in these
places, from being, by some accident, detained there, in consequence of
which the quantity of the poison is increased by assimilation. This
opinion, with regard to the influence of the venereal virus in producing
the disease, will lead to a different conjecture concerning the
operation of mercury, as tending to destroy it.
If this opinion be true, the venereal poison may be supposed to be
productive of disease, only when collected at particular parts. This
would lead us to conclude, that, if mercury possess a power of
destroying the venereal virus when it comes in contact with it, it can
only produce a cure of _lues venerea_ from being topically applied to
the poison collected at particular parts of the body. Mercury, however,
unquestionably does produce a cure of the venereal disease. If, then, it
can be shewn, that mercury in reality is an antidote to the venereal
virus; and that, previous to its producing a cure, it is topically
applied to those parts in which the venereal virus is lodged, we may
reasonably conclude, that the cure obtained from its use is to be
referred to its action as an antidote from topical application. To
establish this supposition, then, it is first necessary to show, that
the mercury is in reality topically applied to the venereal matter.
Many medicines, taken into the alimentary canal, are known to have the
most powerful effects in the cure of diseases very remote from thence.
While this happens, there are the strongest reasons for believing, that
the medicine itself never passes the alimentary canal, or is in any
respect introduced into the system. In such cases, therefore, it
evidently produces a good effect on parts to which it is never applied.
It may then occur, as a possible supposition at least, that this
likewise may be the case with mercury.
Mercury indeed produces many good effects by its action on the _primæ
viæ_. But, when it is given in any of those forms in which it is of
service in the venereal disease, those cases excepted where it is
immediately applied to the diseased part itself, various phænomena tend
to prove, that it actually does enter the mass of circulating fluids. It
is only, from the introduction of mercury into the system, that various
actions which it exerts in different parts of the body can be accounted
for. Thus, for example, when it excites salivation, whether from being
taken by the mouth, or from being rubbed upon the extremities most
remote from the salivary glands, there is every proof which can be
required that the mercury is actually present at these glands. The taste
alone is sufficient to evince this. From the same mark also, we may be
assured of the presence of mercury in the mouth, even when it is not
introduced into the system in such a quantity as to excite salivation.
In all these cases, the mercury can only reach the mouth in the course
of circulation. But, if it enter the mass of circulating fluids, it
must, from the known and established laws of circulation, be equally
carried to every different part of the body; and, among others, it
cannot fail to be applied to those parts in which the venereal matter
does exist. This first assertion, then, may be considered as
sufficiently established; and, it remains only to show, that mercury,
when it comes in contact with the venereal matter, has a power of
destroying it.
That mercury, when it is exhibited in such a manner as to be capable of
conjunction with the venereal matter, has a power of rendering it
inactive, is an assertion, which, it might be imagined, could be put to
the test of experiment. But, experiments of this nature could not be
performed without hazard; and, in the end, would perhaps be only
undecisive. Although, however, no certain criterion has in this manner
been obtained, there are not wanting arguments to render the opinion at
least highly probable.
In favour of the supposition, that mercury, in reality, possesses a
power of rendering the venereal virus inactive, it may be observed, that
an action in this manner is at least conceivable; and that it is
analogous to what we have an opportunity of observing in other cases of
nature. Many substances which possess the most active powers in nature,
have these entirely destroyed, or totally altered, from combination with
other substances. This holds remarkably of mercury itself, when united
with sulphur. These, taken separately, are each of them substances of a
most active nature; conjoined, the mixture becomes inert, or acts only
as sulphur.
From what has been said, then, it appears, that, in some cases, mercury
by combination loses its active powers. But this fact will appear less
singular, if such a destruction of powers holds not of mercury alone,
but of other substances likewise. That it does, is exemplified in the
mixture of sulphur with different metallics, as in the case of antimony.
In the mixture of acids with alcalines, there is, if not a destruction
of activity, at least a total change of properties. But to multiply
instances of this kind, would be superfluous. Enough has been said to
show, that there is at least nothing inconsistent with the common course
of nature, in supposing, that such a mutual relation takes place betwixt
mercury and the venereal virus. It may then be considered at least as a
possible supposition, that, from the addition of the former, the latter
is destroyed, or rendered inactive.
But the proof of this antidotal power to the venereal virus in mercury,
need not be rested upon a mere possibility. That mercury, in reality,
does possess a power of destroying the activity of this poison, is
rendered, if not certain, at least highly probable, from the
circumstance of its curing venereal ulcers in consequence of topical
application. In daily practice, we have undeniable proof, that mercury,
topically applied, does cure venereal ulcers. This holds not only of
those ulcers to which dressings can be applied, and continued for a
considerable length of time, but of others also more out of reach, where
its application can only be temporary. The advantages obtained from the
different modes of applying mercury to ulcers in the throat, whether in
the form of steam or gargle, sufficiently shew the truth of this
assertion.
The cure produced in all the cases of ulcers to which mercury is
topically applied, is unquestionably to be referred to an immediate
action upon the part. It takes place without any marks of the mercury
having entered the system. And it can by no means be alledged, that, in
such cases, any general affection, such, for example, as an increased
discharge, is produced. But it is perhaps needless to insist on this, as
in those instances the cure is never attributed to any other mode of
operation than that of immediate action. As far, then, as the assertion,
that mercury cures ulcers from topical application, can prove any thing
in favour of its possessing an antidotal power, it may be assumed as an
undeniable fact.
It has indeed been alledged, that the cure here arising from the topical
application of mercury, is entirely to be referred to its action as a
stimulus to those parts to which it is applied. But this is an opinion,
which, for many reasons, can by no means be admitted. Other stimuli
which operate more immediately and more strongly, have by no means an
equal effect. When mercury stimulates in the highest degree, the best
consequences are by no means observed to arise from it. And it often
produces a cure from topical application, where no effects of its
operating as a stimulus can be observed. From these facts, it is
evident, that the cure of venereal ulcers, produced by the topical
application of mercury, can by no means be referred to its stimulant
power. This naturally leads us to ascribe it to some other cause.
In the venereal disease, different parts of the body are ulcerated, and
kept in that state, from the activity of the venereal poison. When,
therefore, these ulcers come to be healed, the natural conclusion is,
that the activity of the virus, which occasioned and supported the
ulceration, is destroyed. But if mercury applied to venereal ulcers does
cure them, when that cure cannot be ascribed to any action of mercury,
either upon the system in general as an evacuant, or upon the part
particularly affected, as a stimulant, may we not, with justice, say,
that it possesses a power of destroying the activity of this virus? in
other words, that mercury is an antidote to the venereal poison? From
this, then, it follows, that the action of mercury as an antidote, is
not merely a thing possible, and analogous to what happens in other
cases of nature; but that the real existence of such a power is
incontestably proved.
To this argument, it may indeed occur as an objection, that mercury does
not in every case, from topical application, produce a cure of venereal
ulcers. This, it might be imagined, should happen, did it operate in the
manner here alledged. But it is to be remembered, that the venereal
virus may often be so situated, while it produces an external sore, as
to be totally out of the reach of any application made to the surface of
that sore. And, even in cases where the seat of the virus is
superficial, the mercury may be applied in such a form as will not
readily admit of a conjunction with the virus. Those cases, therefore,
in which mercury has failed of producing a cure, can never afford any
sufficient reason for setting aside this argument. But, on the other
hand, any one well vouched instance, in which mercury, by being
topically applied, has produced a cure in the manner here alledged, is a
sufficient foundation, for every thing which has been advanced from this
fact, to prove the supposition of its being an antidote to the venereal
poison.
From what has been said, it appears, that mercury is an antidote to the
venereal virus; and that, whether it be introduced into the circulating
system, or used externally only, it comes in contact with the venereal
virus in those parts in which it is lodged, previous to its producing a
cure. It may, then, be reasonably concluded, that the theory formerly
suggested is well founded; and that mercury cures _lues venerea_ from
its power as an antidote, in consequence of its being actually applied
to the venereal matter.
In favour of this hypothesis, it may farther be urged, that it is
confirmed by a proper attention to many phænomena attending the cure of
_lues venerea_ by mercury; while at the same time it is not equally
liable to objection, as the other theories which have been mentioned.
From the supposition of a topical action in the manner here supposed,
the fluid to be acted upon is, as it were, separate and distinct from
the general mass. In this case, then, the objection, that the effects of
the mercury will be taken off from the quantity of matter upon which it
has to act, will not apply. At the same time there is here no necessity
for having recourse to any hypothetical attraction between mercury and
the venereal virus.
It cannot, indeed, be alledged, that, in this case more than in the
former, any obvious change occurs in the appearance of the venereal
matter in consequence of the use of mercury. But the venereal matter,
even in the most detached state in which it ever exists in the human
body, is always blended with a certain proportion of pus and other
humours. From this circumstance, we can never become acquainted with
what is its real appearance. It cannot, therefore, be reasonably
expected, that any changes which take place in it should become the
object of observation. But observation sufficiently demonstrates a
manifest difference in the effects produced by this virus, after the use
of mercury, when compared with those which that virus before produced.
That, therefore, in consequence of the employment of mercury, its nature
is in reality changed, is but a reasonable conclusion.
It was formerly adduced, as an argument in favour of another
supposition, that the cure of _lues venerea_ produced by mercury was
proportioned to the quantity of discharge which the mercury occasions.
This assertion we have already attempted to show is by no means, in
every case, true. It must, however, be allowed, that in some cases it
does hold, and in those cases more especially where the discharge takes
place from the system in general. To account for this on the theory here
advanced, it is only necessary to consider in what manner such a
discharge arises from the internal use of mercury.
These evacuations are, without doubt, to be referred to the mercury
reaching and acting upon the excretories by which they are made. The
quantity of these discharges, then, will, in many cases, serve as a
standard by which to determine the quantity of active mercury
circulating in the system. But, in proportion to the quantity of mercury
which circulates in the general mass of fluids, a greater or less
quantity will come to be applied to every part in the body; and, among
others, to those places in which the venereal matter exists. Upon the
supposition, then, that mercury acts in the cure of _lues venerea_ as an
antidote, it is easy to see how the cure should, in such cases, come to
be proportioned to the quantity of the discharge.
Mercury, as was already observed, does not always produce a cure from
external application. Where this fails, the cure is often effected by
internal use. Mercury, from being used internally, comes to be applied
to parts otherwise inaccessible, and even to the interior surface of
superficial sores, to which, from external application, it cannot
penetrate. From this, it is obvious on what principles the internal use
of mercury co-operates in the cure of _lues venerea_ with external
application; or produces a cure alone where it is not used externally at
the same time.
Although the cure of _lues venerea_ from mercury may often correspond
with the quantity of the evacuation, yet it frequently happens, that,
from the early increase of any one particular discharge, the cure is
frustrated. This is particularly experienced in those patients in whom
the almost immediate effect of mercury is to excite salivation. While
this fact is a very strong objection against the supposition that
mercury cures by operating as an evacuant, it can readily be accounted
for upon the theory here adopted. In such habits, the quantity of
mercury accumulated in the circulating fluids can never be very great,
as it finds a ready outlet from the system.
Besides these phænomena, this theory affords a ready solution for many
others also. From hence it is easy to account for the obstinacy of this
disease after it has affected the bones. When that has happened, the
application of mercury to the part affected, whether it be externally
applied, or taken internally, can only be obtained after long continued
use.
From this also we can learn the reason why the venereal disease will
sometimes return, without any new infection, after a seemingly complete
cure by means of mercury. The disease will be apparently cured, because
the mercury may have totally destroyed the poison at some particular
parts; but it will return from the virus still remaining lodged in
others, to which, from a course sufficient to destroy it in more
accessible parts, the mercury could never penetrate.
It appears then, that to the other arguments formerly adduced in favour
of this theory, may be added, the ready solution it affords for various
phænomena observed with respect to the cure. And, from all the arguments
taken together, it may be concluded, that this theory is to be adopted,
if not as absolutely certain, at least, as less embarassed with
difficulties, and as supported by more probable arguments than any
other.
------------------------------------------------------------------------