Part 11

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+.

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+ELEMENTS+

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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.

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