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

Font size: 10 px 15 px 20 px 25 px 30 px 35 px

Background color: BlackWhiteGrayLight GrayDark GrayDim Gray

Text color: BlackWhiteGrayLight GrayDark GrayDim Gray

Apply/Save settings

Ebook has 219 lines and 31737 words, and 5 pages

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.

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.

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 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.

Besides these phaenomena, 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 phaenomena 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.

The mercurial preparations admitted by the Colleges of London and Edinburgh, contain the most useful and most elegant forms employed in practice, at the time when the last editions of their Pharmacopoeias were published. But even at that time they were by no means to be considered as compleat lists. And, since that time, other preparations of utility in practice have been discovered.

A more full view of mercurial preparations than can be obtained from these lists, and, at the same time, some information with regard to the circumstances in which they differ from each other, may be had from a table of mercurials lately published by Dr Saunders of London. In that table, which, with a very few inconsiderable alterations, is the same with one formerly given out by Dr Cullen, when professor of chemistry at Edinburgh, the different mercurial preparations are reduced to general heads, according to the means employed to render them active. From it, the following is almost entirely copied. The names of the different preparations are here printed in Italics, and taken from the London and Edinburgh Dispensatories, from the new Dispensatory, and from the Edinburgh Pharmacopoeia Pauperum. To these are added, some mercurials introduced by Boerhaave, Astruc, Keyser, and Plenck. From the letters subjoined to each, it will appear from whence the preparations are taken; and, where an asterisk is prefixed to any one, it denotes, that it is to be considered as perfectly analogous to that immediately preceeding.

+TABLE+

+OF+

MERCURIAL PREPARATIONS.

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.

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.

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 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.

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.

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.

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.

Share on: WhatsApp @Hash Facebook Tweet