_Of the Mercurial Preparations intended to act immediately on the
Parts affected with Lues Venerea._
EVERY preparation 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
sufficient data 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 internal use. 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 thus excited, 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 of _lues venerea_
was 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 by _lues 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 of an 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
the most 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 other forms. 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 preparations which 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 the _mercurius corrosivus
ruber_ of the London college, and the _praecipitatus ruber_ or
_calcinatus_ of 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 venereal virus. 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 the _aqua
phagedænica_ of 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 in a 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, with some
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.
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