Part 4

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.

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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.