Part 10

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.

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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.