Read Ebook: Observations on the Operation and Use of Mercury in the Venereal Disease by Duncan Andrew

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PREFACE i

PREFACE.

THE chief purpose of the study of medicine is to acquire the knowledge of a safe and effectual method of curing diseases. The attainment of this end is intimately connected with the public good. Every endeavour to promote it, therefore, may be considered as having some claim to a candid examination. In this persuasion, I submit the following observations to public inspection.

Nothing contributes more to safe and effectual practice, than an acquaintance with those principles on which remedies operate. Hence, inquiries concerning the operation of medicines have been, and ever will be, prosecuted by those who mean to practise on a solid or rational foundation. Many practitioners, indeed, hold every thing that is in the least theoretical, in great contempt. They alledge, that a physician possesses all the knowledge requisite in medicine, who is acquainted with particular remedies which will infallibly cure particular diseases. Could such remedies be discovered, their reasoning would indeed hold good; and medicine, which, of all arts, is in reality the most difficult, would be the easiest. But it is incumbent on those who reason in this manner, to shew, that any such remedies actually do exist. This, however, is a point by no means determined; and, with regard to it, very great doubts may justly be entertained.

Errors in theory, indeed, often mislead in practice; and opinions, supported by numerous arguments, after being long believed, have at length been discovered to be without foundation. But this imperfect state of theory, in place of being any objection to its utility, is an additional inducement to continue, with unremitting ardour, a pursuit in which so much still remains to be done. It is by unwearied assiduity alone that improvement can be expected in any art. The imperfection of theory, then, can be no argument for discontinuing farther attempts to render it more perfect.

Theory in medicine is principally despised by two sets of practitioners, the ignorant and the lazy; the last are unwilling, and the first are unable, to acquire the knowledge of it; and, amidst all their boasted contempt, it will be found, that they principally differ from others in implicitly adopting whatever opinions they first receive. Theory is natural to the human mind; and those who are accustomed to think cannot be satisfied without assigning a reason for every phaenomenon which falls under their observation. Theory by no means precludes observations: On the contrary, it leads to a more minute attention to facts; and in this way opinions, of themselves ill founded, have often given rise to useful discoveries in practice. For these reasons, in treating of mercury in the venereal disease, I have esteemed it necessary to begin with some observations on its operations.

There are few medicines, with regard to the operation of which all practitioners are agreed. Mercury, as well as others, has, in this respect, been a subject of dispute. It is indeed the misfortune of medicine, that many points of great consequence still remain in a very doubtful state. But it affords at least some chance of arriving at truth, that, in the present age, it is never esteemed criminal to differ even from the highest authorities: On the contrary, those whose authority should deservedly have the greatest weight, are unwilling that any farther deference should be paid to their opinion than arises from conviction. He therefore who imagines, that an ill-grounded opinion is generally received, has nothing to restrain him from a candid inquiry. But arguments adduced in favour of any opinion will have little weight, if another be previously received as true. To ensure therefore a fair examination, it is, in the first place, requisite to remove prepossession. These remarks will sufficiently account for the attention I have here bestowed in attempting to refute an opinion different from that which I endeavour to establish.

After having endeavoured to overturn one hypothesis, I have attempted to establish another. The opinion I support is by no means new. The honour of invention therefore must be totally resigned to others; but the praise of broaching novelties is always to be relinquished when it comes in competition with the support of truth; and I should consider myself as having done a great deal, were I able to give satisfactory evidence of any important but doubtful point.

After this inquiry concerning the operation of mercury in the venereal disease, I next proceed to make some observations with regard to its use.

Mercury has been employed in the cure of the venereal disease in a great variety of forms. Most of these, upon their first introduction into practice, have been extolled as the safest and most effectual method of using it in every case. Experience, however, sufficiently demonstrates, that this holds with regard to no mercurial preparation hitherto discovered. Whether such a preparation may yet be discovered, is difficult to say. In this treatise, I have not proposed any mercurial which was not formerly in use. But if, on the one hand, I have no title to lay claim to the merit of a discovery, I cannot, on the other, be charged with being the first proposer of any dangerous practice.

On these subjects, a good collection of observations would unquestionably be of the highest utility. How far I have succeeded, must be left to others to determine. To those who imagine I have not altogether failed, I need offer no excuse for having published. To those who are of a contrary opinion, it will be sufficient to observe, that every attempt to be serviceable should apologise for itself.

Mercury was not unknown to the antients. In the early ages of medicine, indeed, it seems to have been esteemed a virulent poison; but it has now, for some centuries past, been much, and successfully, employed for the purposes of medicine, as well as of other arts.

The Arabians were the first who employed it in the cure of diseases; but they seem to have used it externally only, and applied it for discussing tumors, cleansing ulcers, and curing cutaneous eruptions. Soon after the introduction of the venereal disease into Europe, mercury was found to be the most expeditious and most effectual, if not the only certain, remedy. The advantages which are to be derived from its employment in this disease, both when applied externally, and taken internally, have now been confirmed for a length of time too considerable for allowing the least foundation either to doubt its efficacy, when properly used, or to dread its deleterious effects, when judiciously managed.

The effects of mercury on the human system in a sound state are very various. When mercury, in its crude state, is introduced by the mouth into the alimentary canal, it passes off by stool, without producing any effect. It has indeed been alledged, that in this state, in some morbid affections, it may be useful in removing obstructions by its weight. But it is to be remembered, that, in a great part of its passage through the intestines, it rises in opposition to gravity, and that it is very apt to divide in such a manner as to make its way through very small openings. This effect, then, is perhaps in general, if not always, to be disregarded.

When mercury is prepared in such a manner as to be readily soluble in the fluids of the human body, the effects it produces are much diversified. Its action is often immediately exerted upon the stomach; in which case vomiting is produced. This effect is observed from the use of many mercurial preparations. The brown and green precipitates and calcined mercury act as rough and strong emetics; but the preparation principally used, where it is intended to act as an emetic, is the yellow precipitate, or Turpeth mineral.

Many of those mercurials, which have not such an influence upon the stomach as to produce vomiting, upon entering the intestinal tube, act as purgatives. This effect of mercurials is, among other preparations, particularly remarkable on the use of the Coralline mercury, Prince's powder, or calomel.

Mercurials, which fail in producing either purgative or emetic effects, frequently act as diaphoretics. Diaphoresis, or even a profuse sweat, is often the consequence of many of the mercurials already mentioned. But when this effect is wanted, by means of mercurials, it is most commonly obtained by the use of a solution of corrosive sublimate.

Mercury entering the circulating system exerts particular effects on different excretories; but in a more especial manner on those of the saliva. Salivation is an effect which may be obtained from the proper administration of almost every mercurial preparation; but for this purpose either the mercurial pills, or friction with mercurial ointment, are most frequently employed.

From these various modes of operating, it may readily be concluded, that mercury must be a powerful remedy in the cure of many diseases. The undoubted effects which it produces on the human system, when labouring under the venereal distemper, it would be both difficult and unnecessary fully to enumerate. It heals ulcers, removes swellings, alleviates pains, and cures eruptions. In short, the almost infinite variety of symptoms under which this disease makes its appearance may, by a proper application of mercury, be effectually eradicated from the constitution.

From these effects, it is not surprising, that, in this distemper, mercury is the almost universal remedy. But, while it cannot be denied that peculiar advantages may be reaped from the employment of mercury in the venereal disease, it must at the same time be acknowledged, that, from the injudicious use of this medicine, very great evils have been produced. Whatever, therefore, relates to its proper administration, must be esteemed of importance. But to determine this, it is in the first place requisite to ascertain the principles upon which it operates. In treating of the present subject, then, an examination of the most probable opinions, with regard to the mode of its operation in the venereal disease, first claim our attention.

The first argument here adduced is, that the good effects of mercury are proportioned to the evacuation which it produces. This assertion, if allowed to be true, might, at first sight, appear to be a very strong argument in favour of the theory here adopted. But it is strong in appearance only; for, although it should be admitted, it in fact proves nothing.

The degree of evacuation which, in any case, arises from the employment of mercury, will, it is natural to imagine, be proportioned to the quantity of active mercury which is introduced into the system. But, in whatever way mercury acts in the cure of the venereal disease, it may then be supposed to act most powerfully when it is present in the system in most considerable quantity. In this point of view, then, the evacuation which arises from the use of mercury is to be considered merely as an index of the quantity of the medicine which is introduced into the system in an active state; and the cure may be proportioned to the evacuation, only as pointing out the degree in which the mercury exists in the habit. Even supposing, then, that the foundation upon which this argument is built were not to be called in question, yet, taken in its greatest latitude, it is still at best but doubtful; and from it no conclusion can be drawn in favour of the theory which it is brought to support.

In proof of the first of these propositions, we have a convincing example in the difference which is observable between the effects arising from the use of crude mercury, and of this metallic substance, when no other means are used to render it active than simple trituration. It is well known, that even a very inconsiderable quantity, taken in this last way, will soon shew its effects at the most remote excretories of the body; in the other, although swallowed to the quantity of many pounds, it is a very rare occurrence that any effects can be observed from which it can be concluded, that it has, in any degree, entered the mass of circulating fluids.

From the facts as here stated, it indeed follows, that the good effects obtained from mercury are greatest in those cases in which the mercury enters the system in most considerable quantity. The evacuation, it is true, is then likewise greatest. But this will unquestionably follow as the necessary con should be sheltered, otherwise this native of warm countries will have its early leaves and flowers damaged by the wintry blast, and the evil does not stop there, for the check at such a period interferes with the root development, and repetitions of such damage drive the plants into a state of "dwindling," and I may add, this is the condition in which this plant may frequently be seen. Many of the Anemones may be planted without much care, other than that of giving them a little shade from sunshine. The present subject, however, being so early, is not likely to obtain too much bright weather, but rather the reverse. If, then, it is planted in warm quarters, it may be expected to yield its desirable flowers in average quantity compared with other Windflowers, and in such proportion will its roots increase. The latter may be divided when the leaves have died off.

Flowering period, February and March.

Anemone Coronaria.

Hardy and tuberous. The illustration is of the double form, in which it may frequently be seen; also in many colours, as blue, purple, white, scarlet, and striped; the same colours may be found in the single and semi-double forms. There are many shades or half colours, which are anything but pleasing, and where such have established themselves, either as seedlings or otherwise, they should be weeded out, as there are numerous distinct hues, which may just as easily be cultivated. The great variety in colour and form of this Anemone is perhaps its most peculiar characteristic; for nearly 300 years it has had a place in English gardens, and came originally from the Levant. Its habit is neat; seldom does it reach a foot in height, the flowers being produced terminally; they are poppy-like, and 2in. to 3in. across, having six sepals. The leaves are ternate, segments numerous; each leaf springs from the tuber, with the exception of those of the involucre.

In planting this species, it should be kept in mind that it neither likes too much sunshine nor a light soil; under such conditions it may exist, but it will not thrive and scarcely ever flower. When the tuberous roots have become devoid of foliage they may be lifted, and if they have grown to a size exceeding 3in. long and 1in. in diameter, they may be broken in halves with advantage; the sooner they are put back into the ground the better; slight shade from the mid-day sun and good loam will be found to suit them best. When the various colours are kept separate, bold clumps of a score or so of each are very effective; mixed beds are gay, almost gaudy; but the grouping plan is so much better, that, during the blooming period, it is worth the trouble to mark the different colours, with a view to sorting them at the proper time.

The nutty roots are often eaten by earth vermin, especially wireworm. Whenever there is occasion to lift the roots it is a good plan to dress them, by repeated dips in a mixture of clay and soot, until they are well coated; they should be allowed to dry for a short time between each dip; this will not only be found useful in keeping off wireworm and similar pests, but will otherwise benefit the plants as a manure.

Flowering period, May and June.

Anemone Decapetala.

Flowering period, May to June.

Anemone Fulgens.

It may be grown in pots for conservatory or indoor decoration. It needs no forcing for such purposes; a cold frame will prove sufficient to bring out the flowers in winter. Borders or the moist parts of rockwork are suitable for it; but perhaps it is seen to greatest advantage in irregular masses in the half shade of trees in front of a shrubbery, and, after all, it is impossible to plant this flower wrong, as regards effect. To grow it well, however, it must have a moist situation, and good loam to grow in. It is easily propagated by division of strong healthy roots in autumn.

Flowering period, January to June, according to position and time of planting.

Anemone Japonica.

The plant is sometimes much eaten by caterpillars; for this the remedy is soapy water syringed on the under side of the leaves. Earwigs also attack the flowers; they should be trapped by a similar plan to that usually adopted for dahlias.

To those wishing to grow this choice Anemone, let me say, begin with the young underground runners; plant them in the autumn anywhere you like, but see that the soil is deep, and if it is not rich, make it so with well-decayed leaves or manure, and you will have your reward.

Flowering period, August to November.

Anemone Nemorosa Flore-pleno.

This is the double form of the common British species; in every part but the flower it resembles the type. The flower, from being double, and perhaps from being grown in more exposed situations than the common form in the shaded woods, is much more durable; an established clump has kept in good form for three weeks.

The petals , which render this flower so pleasingly distinct, are arranged in an even tuft, being much shorter than the outer or normal sepals, the size and form of which remain true to the type. The pure white flower--more than an inch across--is somewhat distant from the handsome three-leaved involucrum, and is supported by a wiry flower stalk, 3in. to 5in. long; it is about the same length from the root, otherwise the plant is stemless. The flowers are produced singly, and have six to eight petal-like sepals; the leaves are ternately cut; leaflets or segments three-cut, lanceolate, and deeply toothed; petioles channelled; the roots are long and round, of about the thickness of a pen-holder. This plant grown in bold clumps is indispensable for the choice spring garden; its quiet beauty is much admired.

It enjoys a strongish loam, and a slightly shaded situation will conduce to its lengthened flowering, and also tend to luxuriance. Soon after the flowers fade the foliage begins to dry up; care should, therefore, be taken to have some other suitable flower growing near it, so as to avoid dead or blank spaces. Pentstemons, rooted cuttings of which are very handy at this season for transplanting, are well adapted for such use and situations, and as their flowers cannot endure hot sunshine without suffering more or less, such half-shady quarters will be just the places for them.

That these assertions are true, at least of the obvious discharge produced by mercury, will not be refused by any advocate for its action as an evacuant. To this, indeed, they may think it a satisfactory answer, that the influence of mercury as an evacuant cannot be judged of from the apparent discharge. It may be alledged, and indeed with some appearance of reason, that the greatest discharge produced by mercury is by insensible perspiration; that mercury, in consequence of this, is a more powerful evacuant than many other medicines by which a greater obvious evacuation is produced; and that it has the effect to increase perspiration in a more remarkable degree, when it increases no other discharge than when it induces the greatest obvious evacuation. But although it cannot be denied, that the use of mercury does increase insensible perspiration; and that evacuation in this way may, on some occasions, be greater than what would arise from salivation or any other obvious discharge; yet these facts by no means tend to any conclusion which will remove the difficulty formerly stated. Nor can it from thence be supposed, that mercury always evacuates most powerfully in those cases where it produces the most successful cure.

The degree of evacuation which takes place from the employment of any medicine cannot indeed, in every case, be ascertained by the obvious discharge. But, where the judgment formed from this test would be fallacious, the marks of inanition consequent upon the use of any medicine are always certain tests for determining the degree of evacuation. From these it is evident, that the suppositions here advanced, that mercury operates more powerfully as an evacuant than any other medicine, and that it always produces a greater discharge when it acts by the skin, than when it affects the salivary glands, or any other excretory, are entirely without foundation.

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.

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