_Of the Cautions to be observed in the Employment of Mercury in Lues
Venerea._
FEW medicines, 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 those bad
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. It may 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 frequently be 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, determination
to 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 this respect,
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 of life, 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 in the 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 upon this 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
diminishing sensibility, 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 wanted from 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. The only 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 mentioned as claiming attention, regard
peculiarities of constitution where no other disease except _lues
venerea_ can 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 where it 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 where the 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 use of 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 only remains, 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 of _lues
venerea_ by 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 stimulant power. 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 and blandest 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 in the 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 to cold 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 of _lues 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, because the 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
augmentation of 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 proper balance 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+.
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_Lately Published_,
By the same +AUTHOR+,
In one Volume, OCTAVO,