_Of the Mercurial Preparations intended to act in the cure of Lues
Venerea by entering the System._
AN attempt 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 mercury was 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 are in 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 mode
of 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 the system
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 of
_lues venerea_, which can be obtained from this method of introducing
mercury into the system, may be had from the internal use 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 mercury
to 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, with a
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 of care 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 mercury with
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 are all 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 this medicine, 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 the mercury 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 into the 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 of _lues venerea_ where 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,
when compared with many others, may be esteemed mild. There are a
different set, which, in opposition to these, may be termed _acrid_. Of
the acrid preparations, not a few have likewise been used in the cure of
_lues 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 of
_lues 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 introduced into 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 the system 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 into the 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 proportion of 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 not surprising 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. By this 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 use of 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 of _lues 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 the _mercurius 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.
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