Observation on the Use and Abuse of Mercury, and on the Precautions Necessary in Its Employment

Part 1

OBSERVATIONS ON THE USE AND ABUSE OF MERCURY, AND ON THE PRECAUTIONS NECESSARY IN ITS EMPLOYMENT.

BY A. PHILIPS WILSON, M. D. Fellow of the Royal College of Physicians, and of the Royal Society of Edinburgh, &c.

Winchester. Printed and Sold by JAMES ROBBINS.

Sold also by Messrs. CADELL and DAVIES, Strand; MURRAY, Fleet-street; and CROSBY and Co. Stationer’s Court, Ludgate Hill, LONDON.

1805.

OBSERVATIONS, &c.

The following Observations are addressed to the Public, with a view, on the one hand, to do away certain erroneous prepositions respecting the effects of Mercury, which impede the necessary employment of it; and on the other, to call its attention to the impropriety of an indiscriminate use of this medicine, by which much harm is often done, and the medicine itself brought into disrepute. The best way to effect these purposes seems to be, to make the public acquainted with what is really to be apprehended from an improper use of mercury, and the circumstances in which its bad effects shew themselves; by which every one may be enabled to distinguish these effects from such as proceed from other causes, as well as be warned against a use of this medicine which has become too prevalent.

Physicians will agree, that we do not possess a more valuable medicine than mercury. Not to mention the diseases for the cure of which it was first introduced, which, without its aid, almost uniformly prove fatal, and in which it is almost uniformly successful, we may appeal for the truth of this observation to its effects in some of the most dangerous forms of scrophula, in dropsies of different kinds, in inflammations, particularly chronic inflammations, and induration and enlargement of the different viscera.

If we except worm cases, in which mercury probably acts on the worms themselves, the various diseases in which mercury is useful, may perhaps be reduced to the two heads of inflammation and glandular obstruction. I believe there is nothing more erroneous than the opinion, that mercury will occasionally succeed in almost all diseases. This opinion has led to its employment in improper cases, and tended consequently to bring it into discredit. I have never found it successful except in the diseases here alluded to.

For many years after its introduction into practice, it was confined to a few diseases. At length it occurred to physicians, that a remedy, which in these proved so efficacious, might produce similar effects in other cases; and such has been the success of the trial, that during the last twenty years mercury has been coming into general use, with a rapidity unequalled in the history of any other medicine. But the more we are assured of its value, the more cautious we ought to be in its employment; both because it is of the greater consequence to prevent any prepossession against it, and because we know that there is no active medicine which can safely be trifled with.

The prejudices which prevail against the use of mercury seem to arise from three sources; the nature of the complaints in which it was first employed; the uneasiness which even its salutary operation, when carried to a certain extent, necessarily occasions; and the bad consequences which sometimes attend an improper use of it. It is surprising, that the first of these causes should operate against its use; yet such is the confusion which naturally creeps into our ideas on subjects in which we are not habitually interested, that the prejudices of not a few originate from this cause. Of such a prejudice it is surely unnecessary to say any thing. The other objections to the use of mercury are of more weight.

Like all other medicines which increase the secretion by the skin, the use of mercury tends to debilitate, and render the body more susceptible of cold. When mercury does not encrease any other excretion, the debility it occasions seems to be proportioned to the degree in which it promotes perspiration; and medicines which promote perspiration in a greater degree produce more sudden debility. We see a degree of weakness produced by the operation of James’s powders, or of Dover’s powders, (opium and ipecacuanha), in a few days which a moderate course of mercury would not occasion in many weeks.

Such is the tendency of mercury to promote the secretion by the skin, that it often runs off in this way almost as fast as it is received into the system, particularly on its first being used; so that it is sometimes difficult to make a sufficient quantity be retained to produce its desired effect. Some of the good effects of mercury seem, in a great measure, to arise from this action of it, particularly its tendency to counteract the inflammatory disposition and to relieve actual inflammation.

This tendency of mercury readily accounts for the bad effects of taking cold under its influence. It is easy to conceive that the bad effects of checking perspiration will be most felt when, to use a common expression, the pores are most open, that is, when the secretion by the skin is most copious; for the greater the quantity of fluid thus discharged, the greater inconvenience is to be expected from suddenly checking its secretion. Hence also the danger of suddenly checking perspiration, when, by exercise or external warmth, it is rendered more copious than usual.

Such is the admirable constitution of our bodies, that means are provided for more or less successfully counteracting the operation of every thing which tends to injure them. If a thorn or any other extraneous body is introduced under the skin, inflammation and suppuration spontaneously arise, by which the offending cause is expelled. If a poisonous substance is received into the stomach, the action of vomiting is frequently excited, or if it passes into the bowels, nature still endeavours to carry it off by an increase of the peculiar motion of the intestines, and of the secretion from their surface; so in the case before us, the morbid fullness which would in every instance arise, when perspiration suffers a check, is generally prevented by the sympathy which subsists between the skin and several other secreting organs, in consequence of which, as soon as a check is given to the action of the former, some one of the latter, which secrete a similar fluid from the blood, is called into more vigorous action, and what should have passed by the skin is thrown off by the kidneys or bowels, sometimes by the glands of the nose, throat, and lungs, occasioning what we call a cold.

This substitution of one excretion for another, if I may use the expression, is particularly apt to occur under the use of mercury, and seems to arise from the nature of this medicine being so stimulating that we cannot retain it in the system: if one vent is denied it, it quickly finds another. Hence it is that people under the effects of mercury are so subject to an increased secretion from the kidneys and intestines, and from the glands of the mouth and throat.

It is of great consequence in most cases, in conducting a course of mercury, as much as possible to prevent its running off, and as we cannot wholly confine it, our plan is to direct it to that channel thro’ which it passes off most slowly; for it is well known that this and some other medicines, while they particularly excite any one excreting organ, are not apt to pass off at the same time in considerable quantity by any other. Now the channel by which mercury passes off most slowly is the glands of the mouth, and fauces. Our view, therefore, is generally to direct it to this channel, and the degree in which it increases the secretion from these glands is a sufficiently accurate measure of the quantity of mercury in the body, as we generally find that the effects of mercury in removing disease are proportioned to the degree in which it affects the mouth. Besides the discharge, and consequently the debility, occasioned by the same quantity of mercury, is less when it excites these glands, than when it acts on the skin and bowels.

While it increases the secretion from the glands of the mouth and fauces, it irritates and inflames them, and the inflammation it excites when the quantity which passes in this way is great, often becoming considerable and spreading to neighbouring parts, much uneasiness is sometimes occasioned.

The symptoms of salivation form the chief of the bad effects, which are peculiar to this medicine. They are indeed unpleasant, but they are unattended with danger. It is rarely proper to induce them. A physician may practice for several years without meeting with one instance in which salivation is necessary; and the extent to which the older practitioners were accustomed on every occasion to carry the use of mercury, may be regarded as one of the greatest abuses which have opposed the beneficial employment of this medicine. It has certainly more than any other tended to confirm the prejudices against it. All its good effects can in most cases be obtained by slightly affecting the mouth, and keeping up this affection for a longer or shorter time, according as the complaint proves more or less obstinate.

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