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Title: Observations on the Operation and Use of Mercury in the Venereal Disease
Author: Duncan, Andrew
Language: English
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AND USE OF MERCURY IN THE VENEREAL DISEASE ***
* * * * *
OBSERVATIONS
ON
+MERCURY+.
* * * * *
------------------------------------------------------------------------
OBSERVATIONS
ON THE
OPERATION AND USE
OF
MERCURY
IN THE
VENEREAL DISEASE.
BY
ANDREW DUNCAN, M.D.
Fellow of the Royal College of Physicians, Edinburgh.
❦
_Longe mihi potior cura est veritatis quam novitatis._
MORGAGNI.
+EDINBURGH:+
Printed for A. KINCAID and W. CREECH;
and for T. CADELL in the Strand, and
J. MURRAY in Fleetstreet, London.
----------
M,DCC,LXXII.
------------------------------------------------------------------------
To DR WILLIAM CULLEN,
+SIR+,
AN address of this nature can add nothing to your reputation. And
professions of gratitude are but an inadequate return for real services.
When, therefore, I inscribe this performance to you, it is neither my
intention to enlarge upon your character, nor to recount the many
obligations for which I am indebted to you. But, as I am happy in being
favoured with your countenance, and proud of the honour it does me,
allow me to take this opportunity of expressing it.
As I have long since adopted the wish, permit me, on this occasion, to
use the language of a celebrated English Poet:
O! while along the stream of time thy name
Expanded flies and gathers all its fame;
Say, shall my little bark attendant sail,
Pursue the triumph and partake the gale?
And shall this verse to future age pretend
Thou wert my guide, philosopher, and friend?
I am SIR,
With unfeigned esteem,
And sincere regard,
Your much obliged,
And most obedient Servant,
THE AUTHOR.
------------------------------------------------------------------------
CONTENTS.
PAGE.
PREFACE i
CHAP. I. Of the general Properties 13
of Mercury
II. Concerning the opinion, 22
that Mercury cures Lues
Venerea by the
Evacuation which it
produces
III. Concerning the opinion 57
that Mercury cures Lues
Venerea, by acting as
an Antidote to the
Venereal Matter
IV. Of the different 86
Mercurial Preparations
employed in Medicine
V. Of the Mercurial 98
Preparations intended
to act immediately upon
the Parts affected with
Lues Venerea
VI. Of the Mercurial 117
Preparations intended
to act in the cure of
Lues Venerea, by
entering the System
VII. Of the Cautions to be 146
observed in the
Employment of Mercury
in Lues Venerea
------------------------------------------------------------------------
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.
Few diseases are at present more common than _lues venerea_. For its
cure, mercury is a medicine which is almost universally employed; and
the efficacy with which it operates has long been confirmed by
unquestionable experience. But the successful employment of mercury in
this disease requires very particular attention; and it is to be
regreted, that, while many suffer from the distemper, not a few fall
victims to what is used as the remedy: All therefore that has hitherto
been said on this subject by no means supersedes farther attempts to
improvement. To advance the practice of medicine in this particular, is
the intention of the present publication.
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.
With certain limitations, some few such remedies may perhaps be allowed
to exist. But no one will pretend, that these can, in every case, be
employed with equal success; or that, in all circumstances, they are to
be used in the same manner. By a knowledge of the principles upon which
a medicine operates in curing a disease, we can alone be enabled to
accommodate its use to particular circumstances. He therefore who knows,
not only that a certain remedy will cure a particular disease, but is
likewise acquainted with the manner in which it acts in producing that
effect, has at least a double advantage.
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 phænomenon 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.
It is an opinion taught, and at this place very generally received, with
regard to the operation of mercury, that the good effects it produces,
in the cure of _lues venerea_, are to be ascribed to the evacuation
which it occasions. After attentively examining this hypothesis, I
cannot help thinking that it is ill founded. Notwithstanding, therefore,
the authority by which it is supported, I have, with freedom, stated
what to me seem strong objections against it.
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.
In treating of the use of mercurials in _lues venerea_, my aim has been
different from that of most authors. What I have principally had in
view, is not so much to recommend any particular preparation, as to
determine the comparative advantages of some of the most effectual ones
at present in common use. I have likewise endeavoured to point out those
circumstances to which each is best adapted. To this I have subjoined
the principal cautions to be observed in the employment of mercurials;
those more especially which respect the nature of the medicine, the
condition of the patient, and the necessary regimen.
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.
------------------------------------------------------------------------
CHAP. I.
_Of the General Properties of Mercury._
MERCURY is a production of the mineral kingdom. In its natural state, it
is of an opaque metallic substance, of very considerable specific
gravity. To the eye, it appears like melted lead, or silver; from which
it has derived the name of _quicksilver_. In this condition, when freed
from every admixture, it has neither any perceptible smell nor taste;
and, as its application to the most sensible parts of the body occasions
no irritation, we may conclude, that it is void of all acrimony.
By very intense cold, artificially excited, mercury may be brought to a
solid form; but, in the greatest natural cold hitherto known, it remains
always in a fluid state. By heat it is rendered very volatile, exhaling
totally in fumes; these fumes, upon being exposed to cold, condense
again into running mercury.
Mercury, like most other metallic substances, is found in the earth,
either in a pure state, or in that of an ore. The first has been called
_virgin-mercury_, and is in general found by the miners in drops or
small grains; sometimes indeed it is observed in larger quantities, and
forms the appearance of small streams. In the state of ore, it is most
frequently combined either with sulphur, or with earthy matters; from
which it is readily extracted by distillation. It is found in both these
states in different places of Europe, particularly in Spain and in
Hungary; but Britain is principally supplied with it from the
East-Indies.
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.
Mercury may enter the system, exist in considerable quantity there, and
be carried off by the different excretories, without producing any
remarkable evacuation, or other apparent change, on the sound state of
the body. That it is actually present in the system in such cases, is
demonstrated by a general tendency to an increase in all the secretions.
Mercury in this way, although it produces no visible effect on a healthy
person, often procures the removal of a diseased state. Its action,
therefore, in such circumstances, is termed _alterative_; an effect
which may be obtained from most of the mild mercurials, especially when
used in small doses.
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.
------------------------------------------------------------------------
CHAP. II.
_Concerning the Opinion, that Mercury cures the Lues Venerea by the
evacuation it produces._
THERE are few medicines with regard to the operation of which all
practitioners are agreed. It is, however, by no means incumbent on him
who means to establish the truth of any one opinion to overturn every
hypothesis advanced on the same subject. But, as the arguments urged in
favour of any hypothesis will have much less weight when another is
previously believed to be true, and as the regulation of practice is, in
every case, to a certain extent, founded upon theory, no inconsiderable
advantage may be derived from overturning an ill-founded opinion,
especially when it is generally received. The theory of the action of
mercury, as well as of other substances, has afforded room for a
diversity of opinions. For the reasons mentioned above, then, although
it is by no means intended, that every opinion, with regard to the
operation of that medicine, should here be considered; yet, as it is a
very prevailing opinion, that the good effects obtained from mercury in
the cure of _lues venerea_, depend upon its action as an evacuant; and,
as a variety of seemingly strong arguments have been adduced in favour
of that hypothesis, it will be necessary to examine how far they are
sufficient to establish its truth.
In favour of the opinion, that mercury cures _lues venerea_ by acting as
an evacuant, the following arguments have been employed. It is alledged,
that the good effects obtained from mercury in the cure of this disease,
are in proportion to the evacuation which it produces; that the cure
produced by mercury depends more upon the stimulant power of the
preparation which is employed, than upon the quantity taken; and that
the same good effects are obtained from other evacuants as from mercury;
particularly, that the venereal disease is cured in a similar manner
from the employment of guaiac. The arguments here enumerated, if not the
only ones upon which this opinion is founded, are at least those which
are principally employed. To examine, then, how far these are well
founded, will be sufficient.
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.
But, even previous to this, it might be made a question, how far what is
here assumed as a fact is well founded? And if it should appear, that
mercury does not cure _lues venerea_ in proportion to the evacuation
which it produces, a strong argument might from thence be brought
against this theory. But what may be said on this question will, with
greater propriety, occur when the objections to the theory come to be
adduced, than in attempting to refute and invalidate the arguments
brought in its favour. At present, it will be sufficient to show, that,
even allowing it to be true, it is no argument in favour of the
supposition.
If it be true, that mercury cures _lues venerea_ in proportion to the
evacuation it produces, it may indeed, with some degree of probability,
be concluded, that the evacuation and cure are not unconnected. And, if
the evacuation is not the cause of the cure, it might at least from
thence be inferred, that both of them depend upon the same cause; but it
no more, unquestionably, follows from thence, that the evacuation is the
cause of the cure, than that the cure produces the evacuation.
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.
The second argument mentioned in proof of the supposition that mercury
acts, in the cure of _lues venerea_, as an evacuant, was, that the cure
produced by mercury depends more upon the stimulant power of the
preparation employed, than upon the quantity of mercury which is used.
This argument may be answered in the same manner with the preceeding. It
is indeed true, that different preparations of mercury, when used in
equal quantities, have by no means equal influence in the cure of _lues
venerea_. There is seldom an opportunity of observing what would be the
effects of the most stimulant preparations, as, in the venereal disease,
they are by no means in common use; and as, from their action on the
alimentary canal, they exert very violent effects, without entering the
circulating system. They, in general, operate very roughly, both as
emetics and purgatives; but it is not clear that, in the venereal
disease, any benefit has been obtained from their effects in either of
these ways. It can therefore by no means be allowed, that the foundation
of this argument, in its full extent, is strictly true. It cannot indeed
be denied, that some preparations of mercury, which possess a
considerable stimulant power, have a greater influence in the cure of
_lues venerea_, than several others which are less stimulant. So far,
then, the foundation upon which this argument is built, must be allowed
to be just, and its weight, as tending to establish this theory,
requires a refutation.
But, even admitting it to be just, without any reserve, still, no more
than from the former, can any conclusion be drawn from this in favour of
the theory which it is meant to support. It has already been observed,
that, in whatever way mercury operates in the cure of _lues venerea_,
its good effects may always be supposed to be proportioned to the
quantity of the medicine which enters the system in such a state as to
become active there. But the quantity of active mercury entering the
system can in no case be judged of from the quantity of the preparation
which is employed. One preparation of mercury much more readily admits
of a mixture with the animal fluids than another; in consequence of
this, it will find a more ready entrance into the system. And further,
this variety in the facility of access into the system, not only holds
in different preparations, but even in the same preparation at different
times.
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.
But it was likewise alledged, that mercury, used at different times,
although given in equal quantities and in the same form, produces very
different effects. Crude mercury, as has already been observed, although
swallowed in considerable quantities, rarely produces any other effect
on the body, than what arises from the passage through the alimentary
canal. This, however, although generally, is not universally the case.
On some occasions, when taken in this way, it operates with as great
activity as when used in any other form; and, from many well attested
instances, it appears, that, by being swallowed even in a crude state, a
high salivation has been excited. In this we have an instance in which a
remarkable difference of effect arises from the employment of the same
preparation at different times. This difference cannot arise from the
quantity of mercury employed; for while, in some cases, no operation of
the nature here mentioned takes place from the use of a large quantity,
in others, it will be excited where an inconsiderable quantity only has
been taken. The difference of effects here observed, then, must be
ascribed to some other cause; and it is most reasonable to refer it to
particular accidents in the constitution at the time the medicine is
used. In these cases, where no operation takes place from its use, it
may be concluded, that the whole quantity of mercury swallowed has
passed through the alimentary canal in the same state in which it was
taken in. When, on the other hand, an operation upon the salivary
glands, or any other excretory remote from the alimentary canal, is
observed from the use of crude mercury, it may be concluded, that part
of the mercury, from some peculiarity in the habit at the time, such,
for example, as the presence of superabundant acid in the stomach, has
been brought into such a state as to be capable of entering the
circulating system. From these instances, then, it evidently appears,
that the facility with which mercury enters the system, admits of very
great variety. And from this a strong objection may be adduced against
the argument here brought to support the hypothesis that mercury cures
_lues venerea_ by its evacuant power.
It is alledged, that mercury cures _lues venerea_ by the evacuation it
occasions; because the good effects derived from its employment are
observed to be more in proportion to the stimulant power of the
preparation which is used, than to the quantity of mercury taken. The
data, however, here assumed by no means lead to the conclusion deduced
from thence. The most stimulant preparations of mercury, by their action
on the _primæ viæ_, are in general immediately expelled from the system.
When this happens, they have no influence in the cure of venereal
complaints. When they are not thus expelled, their nature is such that
they most readily enter the system. Their superior action, then, may be
accounted for without supposing that it depends on their producing the
most considerable evacuation.
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 consequence of the presence of active mercury in the
system, and can by no means be concluded to be the cause of the cure.
The evacuation which occurs in this case, then, as was observed in the
objections adduced against the last argument, can be considered only as
an index of the quantity of active mercury which is present in the
system. The superior activity, therefore, which some stimulant
preparations possess, when compared with those of a milder nature, is by
no means a proof of the supposition that mercury cures _lues venerea_ by
means of the evacuation which it produces; and this argument, as well as
the former, may be set aside.
The third argument mentioned in favour of this theory, and the last
which we proposed to consider, is, that the same good effects, in the
cure of _lues venerea_, may be obtained from the employment of other
evacuants, as from that of mercury; and particularly, that the venereal
disease is cured in a similar manner by the use of guaiac.
This argument, if well founded, would indeed be a conclusive proof of
the theory, in support of which it is here adduced. Evacuation may be
occasioned by a great variety of other means besides mercury. The
influence of any discharge, as tending to cure _lues venerea_, will fall
more particularly to be considered in stating the objections against
this theory. A full answer, then, to the first part of this argument,
would at present be superfluous: But it may be observed, that it is by
no means a common practice to attempt the cure of _lues venerea_ by the
safest and most effectual evacuants now in use; and that, when evacuants
are employed for the cure of other diseases, while a venereal infection
at the same time exists in the system, it is never found to yield to
them. This first part of the argument, then, may be shortly answered, by
denying it to be true.
It is indeed true, that much benefit has been alledged to be obtained
from guaiac in the cure of the _lues venerea_. Experience, however, has
sufficiently demonstrated, that these testimonies are not altogether to
be relied upon. The influence of guaiac may perhaps be very considerable
in certain stages of _lues venerea_, when the malignity of the disease
is already overcome by means of mercury; or in particular climates,
where the nature of this infection seems to be in some degree different
from what it is in this country. But, how far the good effects of guaiac
are established by facts in this climate, and before a cure has been
attempted by mercury, is still a matter of great doubt. And, at any
rate, even the most sanguine advocates for the use of guaiac will allow,
that the good effects obtained from its use are by no means to be put in
competition with those which are derived from the employment of mercury.
But, even admitting all that has been said in favour of guaiac to be
strictly true, still it does not follow, that it cures the _lues
venerea_ by evacuation. Many medicines which operate much more
powerfully as evacuants have no such effect. And, what was formerly said
with regard to the cure of _lues venerea_, being proportioned to the
evacuation produced by mercury, may perhaps, with equal justice, be
applied to guaiac. It cannot be, with certainty, concluded, that the
evacuation in either case is to be looked upon as the cause of the cure,
since, in both, it may only be its concomitant. From this argument,
then, nothing can be inferred, which has any tendency to establish the
truth of the theory in support of which it is adduced.
Thus have we examined the different arguments used in favour of the
supposition, that mercury cures _lues venerea_ by acting as an evacuant.
And, from this examination, it appears, that they admit of satisfactory
answers. What has then been said in proof of the theory, can by no means
be considered as sufficient to establish its truth. But the
insufficiency of the arguments adduced in support of it, is not the only
reason for not adopting it. There are many objections to this
hypothesis, which would have been sufficient for rejecting it, even
supposing that the arguments brought to prove it had been such, that no
falacy in them could have been detected. That this theory, then, may,
with less hesitation, be set aside, it will be necessary to mention a
few of these objections.
It obviously occurs as a first objection to this theory, that
evacuation, from its nature, cannot easily be supposed capable of
producing a cure of _lues venerea_. The changes which evacuation may
produce upon the fluids of the body, can only be conceived to be of two
kinds. They must either depend on a diminution of the quantity of the
fluids, or on a change of their quality. But, it is not easy to conceive
how the effects of the _venereal virus_ should be removed, or on what
footing this virus should be expelled from the system, by either of
these changes, when induced by evacuation.
A mere diminution of the quantity of circulating fluids, is certainly
insufficient for the cure of _lues venerea_. The venereal matter, as
present in the body, must either be diffused through the whole mass of
fluids, or confined to particular parts only. If it be diffused through
the whole mass, the taint, even after the most considerable evacuations,
will remain equally strong in the fluids still left in the body. And, as
the venereal virus evidently possesses a power of assimulation, when in
the human system, the whole mass of fluids would soon return to its
former state. This being the case, then, it must be allowed, that an
inconsiderable diminution of quantity cannot reasonably be supposed to
counteract an infection which exists in the remaining mass.
If, on the other hand, the venereal poison be supposed to exist only as
a noxious matter in the body, when collected at particular parts, it is
equally difficult to conceive, how evacuation from its nature should
produce a cure. It never has been observed, that mercury particularly
encreases the discharge by those parts where the venereal matter appears
actually to exist. In almost every case where it is used only
internally, there is no encrease of evacuation by venereal ulcerations.
It cannot, however, be imagined, that a discharge which takes place by
the salivary glands or skin, will particularly evacuate what is lodged
in the genitals, or extremities. We may therefore, with certainty,
conclude that evacuation does not at least cure _lues venerea_ by any
change arising merely from a diminution of the quantity of circulating
fluids.
Evacuants may perhaps be alledged to operate in the cure of _lues
venerea_ in another manner. It may be supposed, that they remove the
distemper from a change which they produce in the quality of the
circulating mass. But, from the smallest consideration, it will appear,
that this supposition is equally unsatisfactory as the former. If, from
evacuation, a diminution takes place equally from every part of the mass
of circulating fluids, no change of quality will ensue. If, however,
this proportion is not properly observed, a change of quality will
indeed take place. But that change will consist merely in the diminution
of particular parts in a compound mass, and can never be supposed to
remove a contagious matter of any kind, even supposing it to be lodged
in the particular part of that mass thus diminished. Much less will it
remove an infectious matter uniformly diffused through the whole parts
of the compound mass, or existing as a morbid matter in particular parts
of the body only. From the nature of evacuation, then, whether it be
supposed to operate by a diminution of the quantity of circulating
fluids, or by any change it can produce in point of quality, it may
readily be concluded, that it is by no means fitted for the cure of
_lues venerea_.
Another and more conclusive objection against the supposition that
mercury cures _lues venerea_ by evacuation, is, that this disease is by
no means cured by evacuation taking place in an equal, or even in a
greater degree, from other causes. This, however, should of necessity be
the case, were the former supposition well founded. Effectually to
overturn this theory, then, it will be necessary only to establish the
truth of this assertion.
It cannot perhaps be alledged, that any fair trial has ever been made of
evacuation, instituted solely with a view to cure the venereal disease,
and that in such cases it has been found to fail. But, without any such
trial, there are sufficient arguments to shew, that for this purpose it
really is ineffectual.
_Lues venerea_ would never, upon its first introduction, have been
considered as so unconquerable a disease, could it have been cured by
evacuation. Various modes of evacuation were then in common use in
medicine, and considered as the most effectual means of cure in many
diseases. The venereal distemper, till the introduction of mercury,
resisted the power of almost all the medicines employed against it; and,
in some parts, it was at that time reckoned so incurable, that the
police of the country obliged the unhappy sufferers who laboured under
it to separate themselves from all intercourse with the rest of mankind.
While this was the condition of the distemper, is it to be imagined that
every method of cure was not tried? May we not, then, conclude, that,
upon the first introduction of this disease, evacuation, by every known
means, and carried to the greatest height, was had recourse to, but
without effect?
But, to prove that evacuation will not cure the distemper, it is
needless to travel back to the first periods of this disease, or to rest
the evidence even upon the highest probability. From what occurs in many
morbid cases, we have every day evident proof of the insufficiency of
any discharge for producing a cure of the venereal disease. _Lues
venerea_ often exists at the same time with diseases in which an
increase of natural evacuations takes place. None of these diseases,
whether the evacuation happens by the salivary glands, as in small-pox,
by stool, as in dysentery, or by the skin, as in intermittents, have
ever been found to break its force, much less to produce a perfect cure.
Besides what happens in natural evacuations, we have likewise proofs of
the insufficiency of artificial evacuations for the cure of this
disease. Although evacuation, at least by other means than by the use of
mercury, is never now employed as a cure for the venereal disease; yet
venereal complaints are often complicated with others, for which various
evacuations are proper. And while evacuations are, with success,
employed for the cure of these, it is found, that the venereal taint
either remains unchanged, or is even increased in force. It cannot here
be alledged, that the difference of effect depends upon the mode of
evacuation. On such occasions, every mode of evacuation has been tried
with equal want of success. Even salivation, which was long considered
as the only effectual discharge, when excited by other means than by
mercury, or even by mercury itself, when externally applied to the
organs secreting saliva, has not been found more effectual than other
modes of evacuation. In some cases, indeed, mercury received into the
mouth by steam, or otherwise, has had good effects; but these were
either to be accounted for from its application to the diseased part, or
from its introduction into the system. It is, then, sufficiently
evident, that evacuation, at least by other means than mercury, does not
cure _lues venerea_.
To this theory it may be urged as a third, and not less powerful
objection than any of the former, that where the evacuation arising from
the use of mercury in _lues venerea_ is the greatest, the cure is often
retarded; and that mercury never more frequently fails than in those
cases where it begins to evacuate upon its first introduction into the
system.
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.
From the marks of inanition appearing in the system, it is
demonstratively proved, that, from a variety of other means, a greater
evacuation can be produced than from mercury. In such circumstances,
however, by mercury the venereal disease is cured, by these other
evacuants it is not. And farther, where the cure of _lues venerea_ has
been retarded by a salivation occurring early, or where no cure has
taken place after salivation has been continued for a considerable time,
there is every mark of a much higher degree of inanition than when the
disease has been removed by mercury without any sensible evacuation.
There can remain no doubt, then, that the cure of _lues venerea_ is by
no means in proportion to the evacuation which it produces. This,
however, should necessarily be the case, were the cure effected by
evacuation.
Upon the whole, then, from what has been said of this theory of the
action of mercury in the cure of the _lues venerea_, it appears, that
the cure can by no means be referred to the evacuation. The different
arguments adduced in favour of that theory, we have endeavoured to shew,
either proceed on wrong principles, or, although admitted in their
greatest latitude, can afford no ground for any conclusion to support
it. Evacuation, from its nature, whether supposed to operate by
diminishing the quantity of circulating fluids, or by any change it can
induce in their quality, can scarce be conceived to be a cause adequate
to the cure of _lues venerea_. Evacuation does not produce a cure of the
venereal disease, when it takes place in an equal, or even in a much
greater degree, from the employment of other medicines, than when the
disease is effectually removed from the use of mercury. And, _lastly_,
the venereal disease is never more effectually cured by mercury, than
when it is evident, from every mark by which the degree of evacuation
can be determined, that the evacuation arising from it is least
considerable. It may, therefore, with confidence be asserted, that
mercury does not cure _lues venerea_ by evacuation.
------------------------------------------------------------------------
CHAP. III.
_Concerning the Opinion, that Mercury cures Lues Venerea, by acting as
an Antidote to the Venereal Matter._
IT is an undoubted fact, that mercury, by proper management, cures _lues
venerea_. From the arguments already adduced, it has been concluded,
that the cure, thus obtained, is not the consequence of evacuation.
Having rejected this prevalent opinion, then, it next remains to say, in
what manner a cure is produced.
It has long been an opinion, very generally received, that mercury is a
substance capable of destroying the venereal virus; or that, from being
united with this virus, possesses a power of rendering it inactive. Many
arguments tend to prove, that this is in reality the case; and that in
this manner it cures _lues venerea_. But, at the same time, this theory
is not to be considered as without difficulties. The first that occurs,
is, with regard to the mode in which an opportunity is afforded for a
mixture of the mercury with the virus.
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.
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.
If this opinion be true, the venereal poison may be supposed to be
productive of disease, only when collected at particular parts. This
would lead us to conclude, that, if mercury possess a power of
destroying the venereal virus when it comes in contact with it, it can
only produce a cure of _lues venerea_ from being topically applied to
the poison collected at particular parts of the body. Mercury, however,
unquestionably does produce a cure of the venereal disease. If, then, it
can be shewn, that mercury in reality is an antidote to the venereal
virus; and that, previous to its producing a cure, it is topically
applied to those parts in which the venereal virus is lodged, we may
reasonably conclude, that the cure obtained from its use is to be
referred to its action as an antidote from topical application. To
establish this supposition, then, it is first necessary to show, that
the mercury is in reality topically applied to the venereal matter.
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.
Mercury indeed produces many good effects by its action on the _primæ
viæ_. But, when it is given in any of those forms in which it is of
service in the venereal disease, those cases excepted where it is
immediately applied to the diseased part itself, various phænomena tend
to prove, that it actually does enter the mass of circulating fluids. It
is only, from the introduction of mercury into the system, that various
actions which it exerts in different parts of the body can be accounted
for. Thus, for example, when it excites salivation, whether from being
taken by the mouth, or from being rubbed upon the extremities most
remote from the salivary glands, there is every proof which can be
required that the mercury is actually present at these glands. The taste
alone is sufficient to evince this. From the same mark also, we may be
assured of the presence of mercury in the mouth, even when it is not
introduced into the system in such a quantity as to excite salivation.
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 what has been said, it appears, that mercury is an antidote to the
venereal virus; and that, whether it be introduced into the circulating
system, or used externally only, it comes in contact with the venereal
virus in those parts in which it is lodged, previous to its producing a
cure. It may, then, be reasonably concluded, that the theory formerly
suggested is well founded; and that mercury cures _lues venerea_ from
its power as an antidote, in consequence of its being actually applied
to the venereal matter.
In favour of this hypothesis, it may farther be urged, that it is
confirmed by a proper attention to many phænomena attending the cure of
_lues venerea_ by mercury; while at the same time it is not equally
liable to objection, as the other theories which have been mentioned.
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.
It was formerly adduced, as an argument in favour of another
supposition, that the cure of _lues venerea_ produced by mercury was
proportioned to the quantity of discharge which the mercury occasions.
This assertion we have already attempted to show is by no means, in
every case, true. It must, however, be allowed, that in some cases it
does hold, and in those cases more especially where the discharge takes
place from the system in general. To account for this on the theory here
advanced, it is only necessary to consider in what manner such a
discharge arises from the internal use of mercury.
These evacuations are, without doubt, to be referred to the mercury
reaching and acting upon the excretories by which they are made. The
quantity of these discharges, then, will, in many cases, serve as a
standard by which to determine the quantity of active mercury
circulating in the system. But, in proportion to the quantity of mercury
which circulates in the general mass of fluids, a greater or less
quantity will come to be applied to every part in the body; and, among
others, to those places in which the venereal matter exists. Upon the
supposition, then, that mercury acts in the cure of _lues venerea_ as an
antidote, it is easy to see how the cure should, in such cases, come to
be proportioned to the quantity of the discharge.
Mercury, as was already observed, does not always produce a cure from
external application. Where this fails, the cure is often effected by
internal use. Mercury, from being used internally, comes to be applied
to parts otherwise inaccessible, and even to the interior surface of
superficial sores, to which, from external application, it cannot
penetrate. From this, it is obvious on what principles the internal use
of mercury co-operates in the cure of _lues venerea_ with external
application; or produces a cure alone where it is not used externally at
the same time.
Although the cure of _lues venerea_ from mercury may often correspond
with the quantity of the evacuation, yet it frequently happens, that,
from the early increase of any one particular discharge, the cure is
frustrated. This is particularly experienced in those patients in whom
the almost immediate effect of mercury is to excite salivation. While
this fact is a very strong objection against the supposition that
mercury cures by operating as an evacuant, it can readily be accounted
for upon the theory here adopted. In such habits, the quantity of
mercury accumulated in the circulating fluids can never be very great,
as it finds a ready outlet from the system.
Besides these phænomena, 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
phænomena 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.
------------------------------------------------------------------------
CHAP. IV.
_Of the different Mercurial Preparations employed in Medicine._
METALLIC substances in general, when employed for the purposes of
medicine, have been used in many different forms: But none of them,
perhaps, has been exhibited in a greater diversity of preparations than
mercury. Some mercurial preparations have never been employed in the
cure of _lues venerea_; and many formerly in use are entirely banished
from the present practice in this disease. All these may be considered
as unconnected with the subject here treated of. But that the nature of
those preparations which are at present most frequently employed, may be
more clearly understood, there will be no impropriety in taking a
general view of all the preparations of mercury.
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 Pharmacopœias 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 Pharmacopœia 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.
------------------------------------------------------------------------
A
+TABLE+
+OF+
MERCURIAL PREPARATIONS.
I. Mercury rendered active by triture.
a. Without any addition. _Tragea Keyserii._
b. With honey. _Pilulae mercuriales._ E. 1744.
c. With balsam.
_Pilulae mercuriales._ L.
_Unguentum caeruleum fortius et mitius._ L.
_Emplastrum commune cum mercurio._ L.
* _Emplastrum mercuriale._ E.
_Ceratum mercuriale._ L.
d. With resin.
_Pilulae mercuriales._ E.
_Pilulae Æthiopicae._ E.
e. With gum.
_Solutio mercurialis._ Plenck.
_Pilulae mercuriales._ P.
_Syrupus mercurialis._ P.
f. With suet.
_Unguentum mercuriale._ E.
g. With absorbent earths.
_Mercurius alcalizatus._
h. With sugar. _Mercurius saccharatus._ E.
i. With sulphur.
_Æthiops mineralis._ L. E.
_Æthiops antimonialis._ Ph. Paup. E.
k. With bread.
_Pilulae mercuriales._
l. With conserve of roses.
_Bolus caeruleus._
II. Mercury calcined by heat.
a. Alone.
_Mercurius calcinatus._ L.
* _Mercurius praecipitatus per se._
b. With gold.
_Mercurius praecipitatus solaris._ Ast.
III. Mercury sublimed with sulphur.
_Cinnabaris factitia._ L.
_Cinnabaris antimonii._
IV. Mercury rendered saline.
a. By vitriolic acid.
_Mercurius emeticus flavus._ L.
* _Mercurius praecipitatus flavus._ E.
* _Turpethum minerale._ E.
b. By nitrous acid.
_Solutio mercurii._ E.
_Calx mercurii._ E.
c. By muriatic acid.
_Mercurius sublimatus corrosivus_, E. L.
_Mer. praecipitatus albus._ Boer.
_Aqua aluminosa._ E.
_Aqua phagedænica._ E.
_Mercurius violaceus diaphoreticus._ Ast.
* _Flores ammoniaco-mercuriales._
_Solutio mercurii per deliquium._ Ast.
d. By vegetable acid.
_Mercurius tartarizatus._
_Pilulae Keyserii._
V. Saline preparations of mercury rendered milder.
A. By abstracting acid.
a. By calcination.
_Mercurius corrosivus ruber._ L.
* _Mercurius calcinatus._ E.
* _Mercurius praecipitatus ruber._ E.
b. By attraction.
_a._ Of water.
_Pulvis principis._ N. D.
_b._ Of alcohol.
_Mercurius corallinus._ L.
_Panacaea mercurii._ E. 1744.
_c._ Of water and alcohol.
_Arcanum corallinum._ N. D.
_Panacaea mercurii rubra._N. D.
_d._ Of camphire.
_Pilulae e turpetho minerali._ Ph. Paup. E.
c. By attraction and precipitation.
_a._ Of fixed alkali.
_Mercurius praecipitatus fuscus._ E. 1744.
_b._ Of volatile alkali.
_Mercurius praecipitatus._ L.
_Unguentum e mercurio praecipitato._ L.
_c._ Of volatile alkali and copper.
_Mercurius praecipitatus viridis._ E.
B. By addition of mercury.
_Mercurius sublimatus dulcis._ L. E.
* _Calomelas._
* _Aquila alba._
C. By addition of unguent.
_Unguentum citrinum._ E.
VI. Saline preparations of mercury rendered acrid, or kept so.
a. By redissolving precipitate.
_Mercurius praecipitatus solutus._
b. By addition of acid.
_Solutio sublimati cum spiritu salis._
c. By suspending with ammoniacal salt.
_Mercurius corrosivus nitrosus._
* _Ward’s white drop._
_Mercurius corrosivus muriaticus._
------------------------------------------------------------------------
CHAP. V.
_Of the Mercurial Preparations intended to act immediately on the
Parts affected with Lues Venerea._
EVERY preparation of mercury may perhaps, under proper management, be
successfully employed in the cure of the venereal disease. But by much
the greatest number of these preparations neither are, nor ever have
been, in common use for that purpose. To treat, at any considerable
length, of all that are at present in use, would lead to prolixity and
repetition. A few observations on those which, from their being most
successful, are at present most frequently employed, will afford
sufficient data for determining the choice of one preparation in
preference to another.
The different modes in which mercury has been exhibited have very
universally been reduced to two general heads, and referred either to
its employment externally or internally. This division, however, is not
without some degree of inaccuracy. Mercury, when taken internally, is
very universally thrown into the system in general, without any
particular attention to the affected part. When it is used externally,
it is for the most part meant to act immediately on the diseased part.
This, however, is not always the case; and sometimes the only thing
intended by external application is its introduction into the system.
But, when this is the case, its external employment is on precisely the
same footing with its internal use. The proper distinction, then,
depends not so much upon its being used either externally, or taken by
the mouth, as upon the mode in which it is meant to act. Mercury, in
every case, is intended either to act immediately upon the affected
part, or to enter the circulating system.
If there be any truth in what has been said with regard to the action of
mercury, the manner in which, in each of these ways, it comes to produce
a cure, can readily be conceived, and is, at bottom, very similar. But,
at the same time, these different modes of using the medicine are, in
some measure, fitted for different purposes; and the influence which is
exerted in the one way demands attention, which is not always requisite
in the other. These methods of using mercury, then, may, with greater
advantage, be considered separately than together. And what would claim
consideration, in the first place, are those modes of application, in
which the mercury is intended to act immediately upon the affected part.
From the opinion which was long entertained, that mercury, in every
form, was a substance highly poisonous, it is not surprising, that, upon
its first introduction into medicine, it should have been used
externally only. In this way it seems also to have been first employed
in the venereal disease. But, from the tendency which mercury has to
enter the system, when used in any form, it is not surprising that its
effects, as exciting salivation, should soon have appeared from its use
externally. To a salivation thus excited, it was but natural to
attribute the cure. Hence, from its external employment on its first
introduction, there are few clear instances of its efficacy as acting
immediately upon the venereal virus.
It is not, however, improbable, that, even in these early periods, some
part of the influence which mercury had in the cure of _lues venerea_
was to be ascribed to an immediate action on the venereal matter. In
this way the good effects, in many cases, reaped from fomentations of
cinnabar, one of the modes of applying mercury first put in practice,
were certainly, in some measure, to be accounted for. It may, then, be
affirmed, that the use of mercury, so as to act immediately upon the
affected part, is a mode of applying it as early as its first
introduction in the venereal disease. And, from examining the history of
this distemper, as well as the various means which have, at different
times, been employed in the cure, it will appear, that the immediate
action of mercury on parts affected by _lues venerea_, particularly in
places most easily reached, such, for example, as chancres, has always
been a common intention in practice.
But enough has perhaps been said concerning the history of the immediate
application of mercury. The present inquiry is with regard to the
preparations now employed in this way, and the comparative advantage of
each.
Among the first, and perhaps the most common forms in which mercury has
been, and still is applied, with a view of acting immediately upon the
affected part, are the mercurial ointments, cerates, and plasters. In
this, as will appear from the table which has been given, the mercury is
rendered active by division. Little difference can arise from the
substance with which the mercury is combined during the triture. All
these preparations, therefore, may, with propriety, be considered
together. To this head may be referred, the blue ointments, mercurial
cerate, and common plaster with mercury, of the London College; and the
mercurial ointment, and plaster, of the Edinburgh.
These preparations seem to contain a very large proportion of mercury;
and certainly, in their composition, a considerable quantity is blended.
But it by no means follows, that the whole of that quantity is in an
active state, or is in such a condition as to be capable of an union
with the venereal virus. From late observations, it appears, that by
much the greatest part of the mercury, although here rendered invisible,
is still in its crude state. The effect, therefore, to be expected from
them is by no means to be judged of from the quantity of mercury which
has been employed in making them. And they are in reality much weaker
preparations than might be imagined.
These are often employed as dressings to open sores. But the oily nature
of the substances with which the mercury is here conjoined, prevents it
from admitting of a ready union with the venereal virus. On this
account, their power will be still farther diminished than from the
cause formerly mentioned. Hence it may be concluded, that they are not
the most proper mercurial applications for open ulcers. And indeed an
examination of the state of the fact confirms this conjecture. For, upon
inquiry, it will be found, that in such circumstances greater benefit
may be reaped from other mercurial applications.
Mercury is often meant to act in the venereal disease, without any
general affection of the system, or without entering the mass of
circulating fluids, where it cannot come into immediate contact with the
affected parts. These parts are often deep seated, and, at the same
time, the integuments above them are unbroken. In such cases, mercury,
applied in a form capable of penetrating, or of being absorbed, promises
to be of service. That mercury, in the forms here mentioned, is in this
situation, cannot be denied. And, in such cases, these forms have the
peculiar advantage, which many others want, of admitting of an easy,
gradual, and long continued application. Hence it is, that singular
benefit is obtained from them in the resolution of nodes and buboes.
It may not be improper here to observe, that, for these intentions,
particularly the last, which is an affection of the lymphatic glands, it
is a very effectual mode of using the mercury, to apply it in the form
of unction to those places from which the lymphatic vessels passing
through the diseased gland take their rise. In this way, equal if not
greater benefit will, in general, be reaped, than from immediately
applying it to the tumor itself. By this means, the mercury will be
carried with more certainty, and in greater quantity, to the affected
gland, than it would be from pervading the substance of the integuments.
Another form in which mercury was very antiently used, and still
continues to be applied with an intention of acting immediately upon
affected parts, is, its being reduced into a state of vapour, by which
means it acquires a very high degree of activity. This mode of applying
mercury is attended with many inconveniencies, and, in this form, its
application, while it is very sudden, can at best be but temporary. It
must, however, be allowed, that the active form which the mercury here
assumes is a very subtile one. By this means, it becomes capable of
penetrating and resolving hard and indurated tumors, which cannot be
pervaded by mercury in other forms. On this account, in such tumors,
especially if they have been of long standing, and in obstinate ulcers
which have resisted other mercurial preparations, the form of vapour may
often be tried with peculiar advantage. For this purpose, cinnabar has
commonly been employed. From its being resolved into fume, the mercury
and sulphur are disunited, and the activity of the medicine totally
depends upon the former arising in a state of vapour.
Mercury, in whatever way it is used, is most active in these forms in
which, from the addition of acids, it is reduced to a saline state. Some
of these are in their nature so extremely corrosive, that they can
scarcely, with safety, be used even as external applications. This
peculiarly holds of those preparations which are formed by a combination
of mercury with the nitrous acid. That they may be fitted for use,
therefore, various means are employed to render them milder. Among other
methods, one frequently practised, is, the abstraction of acids by
calcination. In this manner are prepared the _mercurius corrosivus
ruber_ of the London college, and the _praecipitatus ruber_ or
_calcinatus_ of the Edinburgh. These are forms of employing mercury
which are every day in use, for application to the part immediately
affected.
These preparations, even after having their action in this manner
diminished, still possess a very considerable degree of corrosive power.
On this account, they become particularly useful in many cases of
venereal complaints, where corrosives are required. And hence it is easy
to learn the foundation for the frequent and advantageous employment of
these preparations in cases of fungous edged ulcers, of warts, and other
such tumors.
That these preparations may be applied more commodiously, they are
frequently mixed with different ointments, particularly with basilicon;
but, by this means, their power of action is greatly diminished. Where
it is intended they should act as escharotics, it is perhaps in every
case most proper to employ them in the form of dry powders. Such
dressings may then be applied above them as are best fitted to the
nature of the complaint.
It may naturally be imagined, that, from mercury in this form, not only
an escharotic power can be obtained, but that likewise, from its action
as an antidote against the venereal virus, parts kept ulcerated, from
the activity of this poison, may be healed. That, in some degree, it is
fitted for this purpose likewise, is not to be doubted. But, to its
employment in this way, its corrosive power is often an objection. In
many cases, where it is required that an ulcer should be healed, a
destruction of solid parts would be highly prejudicial. And when, in
order to avoid this, the corrosive power of the mercury is diminished,
from its being united with an ointment, the precipitate becomes liable
to the same objection which was formerly urged against the efficacy of
mercurial ointment. It is then in a state which does not admit of a
ready union with the venereal virus. It may therefore, upon the whole,
be concluded, that mercury in this form is principally useful in those
cases, where, with the effect of an antidote against the venereal virus,
it is necessary to conjoin an escharotic power.
Mercury may be rendered saline by being united with other acids as well
as the nitrous. These likewise are, in general, active preparations; but
they do not possess a caustic power, at least in so high a degree as the
nitrous preparations. Among the most active of the other saline
preparations, are those prepared with the muriatic acid, and especially
the corrosive sublimate. This is a mercurial preparation which, in many
cases, may be employed to act immediately on parts affected by the
venereal virus; it falls, therefore, to be considered also under this
head.
The stimulant power of corrosive sublimate is so great that it is never,
even for external purposes, used in a solid form. But the _aqua
phagedænica_ of the Edinburgh College, which is a solution of it in
lime-water, is a mercurial preparation which has often been used
externally, both in venereal and other foul ulcers. This form, however,
contains so large a proportion of the mercury, that it is by much too
stimulant for the greatest part of sores. A more dilute solution, in
common spring-water, is free from this inconvenience, while, at the same
time, it serves every purpose which can be expected from the other.
The mercury in this solution is in a state sufficiently active to
destroy the venereal virus, and is, at the same time, in a condition
which will admit of a ready union with it. Good effects, therefore,
might naturally be expected from it, especially as the form is such that
it can with ease be applied.
The efficacy of this preparation has not indeed, as far as I know, been
confirmed by long or extensive practice. But, where it is proper to heal
superficial ulcers, no application is of greater service than dressings
of lint dipt in a solution of the corrosive sublimate in the proportion
of half a grain to an ounce of water. The addition of a small quantity
of compound spirit of lavender to this solution will give it a colour
and smell different from those of common water, which, with some
patients, are necessary conditions to an effectual application. In some
circumstances already mentioned, the other modes of applying mercury to
act immediately upon the diseased part may be preferable to this. But,
where the only requisite to the healing of an ulcer is the destruction
of that venereal virus at the part which supports a diseased state
there, no application will answer the purpose with greater facility,
safety, and expedition, than this solution.
------------------------------------------------------------------------
CHAP. VI.
_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.
------------------------------------------------------------------------
CHAP. VII.
_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+.
------------------------------------------------------------------------
_Lately Published_,
By the same +AUTHOR+,
In one Volume, OCTAVO,
PRICE in Boards, 4 _sh._
+ELEMENTS+
+OF+
+THERAPEUTICS+.
IN this Treatise, the Author endeavours to point out the means by which
the different classes of medicines operate in the cure of diseases; the
indications they are fitted to fulfil; the cautions to be observed in
their employment; and the morbid conditions forbidding their use.
------------------------------------------------------------------------
● Transcriber’s Notes:
○ Missing or obscured punctuation was silently corrected.
○ Typographical errors were silently corrected.
○ Inconsistent spelling and hyphenation were made consistent only
when a predominant form was found in this book.
○ Text that:
was in italics is enclosed by underscores (_italics_);
was in bold by is enclosed by “equal” signs (=bold=)
had extra character spacing by “plus” signs (+stretched+).
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