A view of the mercurial practice in febrile diseases

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ARTICLE XIX.

A VIEW OF THE MERCURIAL PRACTICE

IN FEBRILE DISEASES. 4 a

Part I

SECT. I. GENERAL HISTORY OF THE PRACTICE.

Tue use of mercury in fevers was little known till

. about the middle of the last century ; and it is only

within a few years, that it has been brought into

general notice as a febrifuge, or, as some have con-

sidered it, as a specific in fever of contagious cha-

| racter. It has, however, been gradually gaining

admission into the practice of the first medical men

in the United States, particularly in New England ;

and, at length, constitutes a very important part of the curative treatment of these diseases. 65

So numerous are the genera comprehended under

the class of pyrexiz, and so great a proportion do

they bear to the whole catalogue of diseases ; that an

inquiry into the history, local peculiarities, and pro-

posed methods of cure, must for ever be one of the

Most interesting employments of the physician and

the philosopher.

Ir was my original intention, in this discourse, to have given a general description of the different forms of contagious fever, most prevalent in this and the neighbouring states, for the last twenty years ; chiefly, with a view to ascertain the merits of the mercurial method, which has been adopted within that period. The epidemics have accordingly been particularly the objects of attention. But, as endemial and sporadic diseases have also become the subjects of this treatment, they could not properly be passed over, in making this estimate.

Mercury has been very aptly denominated the Sampson of the Materia Medica. It is the dictate of prudence to be assured, before we admit it into the strong holds of the system, whether it will act the part of a friend, in defending it against the disease that assails it; or, whether it may not be likely to | pull down the pillars of the human constitution. That such suspicions have existed, a history of this practice sufficiently evinces.

In investigating the effects of this medicine upon — the human body, the subject naturally divides itself into the following heads:

Tue nature of the medicine, and of its preparations ;

Irs general operation upon the living body; '

Tue particular diseases in which it has been administered, and the effects produced. ree a.

Unner the first of these heads, it would be proper to. examine such preparations of mercury as are im-

common use. } a a RO ee ee ee Tee ee NCL eee ee x ‘

Unper the second, to ascertain the manner of their operation upon the human constitution. —

Uwoper the third, to collect the experience of such practitioners, as have been in the free use of them in febrile affections, in order to determine m which of them it has proved salutary.

As it would be of no advantage to shew, that mercury is useful in any particular disease, unless its symptoms are so minutely described, that the nature of it may be thoroughly comprehended, and, that when, in future, it shall make its appearance, it may be known to be the same affection, the history of those diseases should be noted, and particular cases subjoined, exemplifying the character of the complaint, atid the method of treatment which was adopted.

Ar present, those only of the febrile class of diseases, in which mercury has been considered as an appropriate medicine, will be adverted to. Smallpox and measles constitute the division of what may be called specifically contagious diseases ; pestilential malignant, and yellow fever, typhus, cynanche maligna and dysentery, that of infectious fevers ; cynanche trachealis, hydrocephalus internus, peripneumony, phthisis and rheumatism, the inflammatory class, in the cure of which, this method has been adopted. _ Tuar all of these may be properly considered as belonging to the class of pyrexiz, will probably ~be generally allowed, whatever may be the difference of opinion entertained respecting their proximate causes.

a fy oa

THERE was a strong prejudice prevailing among the ancients against mercury. Galen considered it as a poison, which was unfit for use as a medicine ; and some physicians were of opinion that it destroyed the stomach by eating holes through the coats of that organ. 3

Tue first, who used it as a medicine, were the Arabians, who cured diseases of the skin by an external application of this metallic substance, in form. of an ointment.

Mr. Astruc thinks, it was from analogical reasoning adopted as a remedy in lues venerea, which was found to be frequently accompanied with cutaneous eruptions.

Tue red precipitate appears to have been the first preparation used internally ; and to this succeeded the use of argentum vivum, with rhubarb and other articles, in form of a pill.

Mercury had seldom been used in any other than venereal complaints, till about the year 1735, when it was adopted as a remedy in the disease called the throat distemper. It had, however, according to an account published by Dr. Holyoke, in the first volume of the New York Medical Repository,* , been introduced in Boston by a disciple of Dr. Pitcairn. ,

Dr. Benjamin Gace, of Connecticut, in a dissertation on the inoculation for the small.pox in America, says, Mercury in small-pox was resorted to first in the American colonies in 1745, when it was emt 1

4 ployed. with success by two eminent physicians, Dr. } ‘Thomas, of Virginia, and Dr. Muirson, of Long Island.. There is no doubt, that the mercurial practice in fevers first obtained credit in America, while many prejudices prevailed against it in Eu-

~ rope.

From the supposed efficacy of this remedy, in the

ulcerous sore throat, it was administered in other fevers ; and was found useful, particularly in pleuri-—

sies and peripneumonies, which were much more prevalent fifty years ago, than at the present day, as

; well as in quinsies, inflammatory. rheumatisms, and

.. other phlegmasiz.

. ? Bur, however successful this practice might have proved in the hands of the most skilful practitioners

of that day, it is certain, that till within these twelve : or fifteen years, it had been gradually losing reputaf tion, or at least falling into disuse, from doubts and uncertainties with respect to its effects on the human

. constitution.

Tue prevalence of the yellow fever in the West Indies, and some of the southerly parts of the American continent, has, however, been the means of in- _ troducing it again to the attention of the faculty. In | that most formidable disease, perhaps partly from '___ accident, and partly from analogical reasoning, mer- ___cury has been exhibited in quantities, which would _ formerly have been considered as inevitably destructive. It had been previously prescribed in inflammatory affections ; ; and, as this fever had frequently as-

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Se ae ee ee ee Ee ee ee a sumed that character, and a great variety of other means had been used without success, it was natural to resort to it; and that Herculean disease was attacked with a medicine, whose powers were supposed. alone equal to its expulsion.

Wuerue_nr the yellow -fever was first introduced into the West Indies in the year 1793, as Dr. Chisholm intimates ; or whether it had been known there as early as the seventeenth century, and from that period had frequently visited, or originated in these islands, it is probable he was, if not the first, one of the earliest practitioners, who considered mercury as the only medicine to be relied on for its cure.

Tue dissections, which had been made for the purpose of ascertaining the proximate cause of this disease, had, in some measure, demonstrated the nature of it; and had proved, that the liver was one of the organs most immediately affected, or im which the marks of derangement were most conspicuous. ~

Tue known eflicacy of mercury in glandular disorders, with its supposed appropriate determination to the liver, was the circumstance which led to the experiment; and to this may be added an opinion not even at this day entirely exploded, that by some specific action of this remedy .on the contagious matter, as in lues venerea, the poison was subdued and expelled from the habit. It was -soon after adopted as the most certain method of controling the ravages of the yellow fever; and has gradually, from this period, insinuated itself into the method of treat-

Fi ee ete SC ee ns pe ee ee eee

7 ment in fevers of almost every description; at least in this metropolis.

Tuart a medicine, against which such strong prejudices existed, a medicine, the operation of which was so directly opposed to the established indications

. of cure in inflammatory diseases, shouid have ob- | tained such ground within the short period of fifteen or twenty years, is a singular occurrence in the annals of our profession.

Tue Physicians in New England, who first used. “mercury, were obliged to conceal it from the knowledge of the patient; and, if salivation ensued, which however for this reason was generally as carefully as

4 possible guarded against, they were sure to incur the resentment of the concerned. : Iw the small-pox, indeed, it had been adopted, es-

~ pecially as part of the preparatory process for inocu-

: lation; but even here it was submitted to as an evil

: almost as formidable as the disease for which it was

. administered; and a promise of carrying thespatient through it without recourse to that medicine, insur-

: ed the practitioner popularity and employment.

ys A crrcuMSTANCE that evinces the strength of this

: prejudice, occurred.in the year 1774. Dr. Latham

i professed to practice the Suttonian plan of inocula- a tion, which was given out to consist in a mode of e

F _ preparation, in which no mercury was used. On

; tk the faith of this supposition, a large hospital was

| “filled with patients in a neighbouring town, and , a Nt _ 4G ae | ‘ie f ‘ 4 4 Bi | as : ! a | Ce ee eS re i : rae + mes ne Ae ee ae ae eee ene eer Teer er re gee Ps ee Pee Ss several classes passed through the distemper with about the usual success. One of the persons in the hospital suspicious of his having taken mercury, had some of the pills which had been given to him, analyzed, and a quantity of quicksilver was revivified from them, Information of this circumstance getting to the ears of the public, a general indignation was excited against the inoculator, as using a noxious and deleterious medicine; and the business of inoculation was soon after suspended.

Tuus was this article secretly used among physicians; and the quantities which they ventured to prescribe were such as at the present day would be considered as of very little importance in the curative process. One or two grains a day was as much as was considered safe in violent diseases, and even by that quantity the constitution was suspected to be — weakened; and whatever disease happened within ten or fifteen years after the use of it, was imputed to the influence of this medicine. Instead of one or two grains, one or two hundred grains a day have of late beén administered, and, as its advocates declare, with safety and advantage.

Ht SECT. Il. MERCURY AND ITS PREPARATIONS. a

Ir is-well known that mercury in its native form, or quicksilver, has no effect upon-the human body, in whatever quantities it may be taken, otherwise _ than. by its ponderosity. pe

‘Tue various preparations of this mineral, in which the globules are rendered invisible, possess various degrees of activity in consequence either of the chemical or mechanical changes which they undergo in the process.

Tuere are several forms of this medicine in which, by some, the change has been considered as the effect of mere trituration and mechanical combination with certain other substances. ‘The blue pill and common mercurial ointment were the articles in which this mode of combination was supposed to take place.

Ir is well known that by triturating for a short time (a few minutes) a quantity of quicksilver with honey and rhubarb, the globules will disappear, and the article be converted into a medicine of very different properties from what it possessed before the operation. From the facility with which this is effected, it has been urged that it was impossible that any oxygen could have entered the composition. If this change is produced by mere mechanical mixture, the only difficulty is to reconcile the activity of its operation with the inert nature of the metal itself, which is said to have been swallowed, frequently to the amount of one or two ounces a day, by many persons, under a foolish persuasion that it secured them from contagion. The preparation of the mercurial ointment too was supposed to consist in the mere trituration of the metal and its minute division and mixture with the lard that was used in the proee =~ oe, ar oN) CU ee ee OTe Te eS NN ee ee Te eee ee eee yD cess. It has been urged that in this form also it was improbable that the metal should have become oxidated, because lard has a stronger affinity to oxygen than mercury, as appears from boiling lard with an oxide, when the metal will be revived, at least in considerable proportion.

Ir has therefore been concluded that neither of these preparations possesses the PRPREES of an oxide of mercury.

Dr. Grover seems however to have satisfactorily

\proved, that oxygen actually enters into combination in both these medicines.* Having carefully triturated a quantity of quicksilver with rhubarb and molasses, until the metal disappeared, he submitted it to the test of washing, which was calculated for the purpose of determining whether the mercury had undergone a chemical change. The rhubarb and molasses are readily miscible with water, the quicksilver not so. On the supposition that the particles of the latter were only divided and mixed with the other articles, the metal ought to have subsided as soon as the rhubarb and molasses, which were interposed between its particles, were suspended in | water. On rubbing the blue pill in a mortar with water, and repeatedly pouring off the liquid, till the powder or syrup was fairly washed out, there was no revivification of the mercury, but this part of the composition fell to the bottom of the vessel in the

* Vide Medical Repository, vol. 6, p. 244.

form of a black oxide. It was therefore chemically changed by the preparation. .

‘THE oxidation of mercury in the blue ointment is rendered extremely probable, from the obvious difference in the effects of bland and rancid oil, or lard, upon this substance, when exposed to their action by trituration. That it owes its rancidness to the absorption of oxygen is incontrovertible; and that the most rancid lard will soonest extinguish the globules of quicksilver, is equally certain. In the act of trituration, the particles of this metal are exposed in ali directions to the action of those of the lard, the superoxygenation of which adapts it to the purpose of reducing that substance, by parting with a portion of its oxygen. As even the most recent lard contains a quantity of this prineiple, it seems probable, that in all cases, when it is used for a similar purpose, it produces the change by means of its oxygen.

Experiments have been made for the purpose of determining this question on the principle of an increase of gravity in all bodies which absorb Oxygen. As most of them have been made, however, by trituration with certain substances, which were capable of supplying a sufficiency of oxygen to oxidate the quicksilver, the weight of the compound could not have been affected, the quicksilver gaining as much weight as the other articles lost, and consequently the result was inconclusive.

Mr. Axyown asserts, that mercury is oxidable even by agitation in air. Whether he weighed the oxide after this operation, I have not been informed ; but, admitting the truth of this proposition, there can be no future doubt of the absorption of oxygen .in the variety of preparations of mercury ; and this would very naturally suggest the suspicion, that the activity of the medicine, in its various forms, on the human constitution, is not only dependent upon, but proportionate to the quantity of this substance which enters into their composition.

OxycENATED muriate of mercury contains most oxygen, and accordingly is the most active of the mercurial preparations.

SECT. Il. THE GENERAL OPERATION OF MERCURIALS ON THE BODY.

TuERE appear to be only three modes in which the phenomena attendant on the use of mercurial medicines can be explained.

Tuerr mechanical operation on the fluids.

THeErR specific action on the noxious matters themselves in the animal body, separate from the consideration of the diseased actions in the body.

THEIR action as a stimulus on the system.

Mechanical action. ‘Tue superior specific gravity of quicksilver gave origin to an opinion, that, whatever were the effects it produced upon the body, they were to be imputed to the momentum of its particles circulating in the blood, after having eee ay ee eee ee 2 ee: ee Pe ee eg, ee pe Se Tee ee eee ee Oe Se eee been minutely divided by the digestive organs, and received into the mass through the lacteals and thoracic duct.

Tue discovery of the circulation, about the middle of the seventeenth century, led to the application of mechanical principles in explaining the animal phenomena. ‘The theory of obstruction corresponded with this hypothesis ; and mercury was conceived. to remove those affections by the force with which it impinged upon the resisting particles of peccant matter which it met with, either in the larger blood vessels, or their capillary ramifications.

Wuew these particles were determined to the intestinal canal, and operated-as purgatives, they were considered as expelling the morbid matter accumulated in these passages ; and when to the glands, the salivary in particular, they were supposed to carry with them the poisonous substances, which had been retained in the system. While passing through the small vessels, they were believed to attenuate the too viscid lymph and other constituents of the mass of fluids ; to force through obstructing matters, contained in the vessels, by an impulse proportionate to the weight of the particles of mercury; and thus to promote a freer circulation, and the removal of disease. ‘ : _ Mr. Asrrvuc says, the globules of mercury, in proportion to their momentum, must increase the circulation by more forcibly striking against the sides of the vessels, and, that wheresoever the poison

2 A a OT eae eee Oe apart —e ee Pee a eee Re ee ee Pe ee wee OMe oe eS ee | Ne PPI CE! LO PEE ES OC ee a Te ee eS I ee AE be Be ee ch, a ery Ce ee ee Oe ee ee ee ee eee ee 7 ey ee re en is lodged, whether in the blood vessels, glands, or other parts, the mercury will seck it out, subdue, and at last expel it by some of the secretories of the body.

Bur the form which mercurial preparations, in their extremely divided state, must assume in the blood, is such as to render this theory utterly untenable; for, though it may be very difficult to detect their chemical properties, yet, if they acted upon mechanical principles, they might undoubtedly be discovered by their weight ; whereas no such ponderous particles have been demonstrated in the blood: nor, '

if there were any, would it be easy to account for such an elective power upon the poison.

Tue second solution of the modus operandi of mercurial medicines, supposes the specific operation of this agent on certain morbific matters in the system. It would be still more unphilosophical than the first, and having been assumed as a cloak for the ignorance of its advocates, it has been reyected by a more enlightened theory.

Puysicians, at the present day, recognise no specific medicines ; and are willing to keep open the door of investigation on such subjects as are unexplained, by acknowledging their want of information, and exciting an inquiry into the more abstruse and unexplored regions of medical science.

Tue opinion, that mercurial medicines produce their effects en the body by acting as stimulants, is probably the most prevalent and the best sepported of any yet advanced.

Tue property of irritability in the animal body is the basis on which this doctrine is constructed.

STIMULANTS may be defined to be such powers as are capable of increasing the action of parts. This they do by operating on the irritable fibre, even when separated from the brain; and by producing sensation under other circumstances. The most obvious effects of mercurials on the body are such as correspond with the phenomena of excitement, or the action of a stimulant, on the irritability. Whether it be called by the name of irritability, or excitability ; whether it be considered as existing separately and independently in particular parts, or as one entire aggregate through the whole system, it is ceriain, that the natural, as well as diseased. actions of the body, depend upon certain agents which operate upon it.

TuHat mercury, ina combined state, is a stimulant, is evident from the following considerations.

MeERcuRIAL preparations increase the action of the stomach and intestinal canal. The peristaltic motion of those organs is by most of the preparations of this mineral sensibly, and by some of them powerfully excited; and the emetic and cathartic effects are among their most active properties.

Tuey act very powerfully on the glandular organs by increasing their secretions, and promoting discharges from the excretories of the skin, salivary glands, and other emunctories, almost without exception, throughout the body.

Tury increase the action of the heart and arte-

‘ries, quickening the pulse in some instances, and in others rendering it stronger and fuller ; consequently increasing the momentum of the circulating blood, and in this way rousing the whole system into action ; and it is this action which. constitutes the febris mercurialis of salivated patients.

SECT. IV. OPERATION OF MERCURIALS AS STIMULANTS.

WHETHER mercurial preparations produce their effects by acting upon the surfaces to which they are.

applied, and so affecting other parts of the system by sympathy, or whether they are absorbed into the vessels, and hence extend their stimulant powers. over the body, has been questioned.

Tuar the emetic and cathartic operation of these medicines depends on their action as compound bodies on the stomach and intestines, I should suppose would hardly be denied, when it is considered, that no known powers exist in these organs, capable of decomposing them so speedily, as those effects are observed to take place. If the ordinary powers of digestion were capable of deoxygenating mercury within their cavities, according to the common rules which govern that function, a longer space of time, it should seem, would be required for the purpose. It is known that no degree of heat exists in the stomach sufficient to reduce these oxides; we may, .

therefore, venture to conclude, that their eyacuant effects depend upon their compound action.on the surfaces to which they are applied.

_ Ir may be next inquired, whether these medicines are absorbed into the blood-vessels, being taken up by the absorbents of those surfaces, and carried into the common mass of blood, thus pervading the ultimate ramifications of that system, even to the secretory organs and exhalants of the body; or whether they act upon the glands, and other remote parts, from sympathy alone.

Ir it could be proved, that they exert their whole effect upon the first passages and the absorbent surfaces in general, there would be no reason to suppose the necessity of any absorption into the system. It would then be granted, that they acted in the same manner with opium, ardent spirits, and animal nutriment, upon first entering the stomach, with an almost infinite number of other articles, many of which have never been supposed to be absorbed.

Tue phenomena of salivation might then be solved on the principle of sympathy ; and both the metal and the oxygen be considered as essentials. ;

Own the supposition that the very extensive effects of those medicines upon the constitution are not to - be accounted for on this hypothesis, search has been made for them in the blood and other fluids.

Ir no deoxygenation could have taken place previous to absorption, (admitting absorption to have taken place) the mercury must have existed, at some period, within the system in its compound state.

For the purpose of detecting any mercury that might have been absorbed into the mass of fluids, I had a number of experiments made upon a patient under the full influence of a mercurial course. In eight days he had taken two hundred and eighty-seven grains of calomel, and used eight ounces of strong mercurial ointment by friction. ‘The: experiments were little varied from those of Dr. Physick, made in Philadelphia, with the same views, and the results were the same. They furnished no evidence that either the blood or the saliva was impregnated ‘with the metallic substance.

Bur these éxperiments, it is apprehended, are not sufficiently conclusive to prove that mercury is not absorbed into the system. It is possible, that some minutely divided particles may lurk in the fluids, though under such forms as to elude discovery. In its combined state, within the blood, it must possess properties very different from those of the simple metal; and its oxygen may render it insusceptible of discovery, by the tests which have been employed.

Tue phenomena attendant on its use justify this conjecture ; and that there are many other substances existing in the blood, too subtle for investigation, the phenomena of poisons and of contagion seem to prove.

Drs. Beppoes and Girtanner originated the doc- _trine, that mercurial medicines act in consequence of their oxygen alone; and Dr. Alyon declares, that he has prepared an oxygenated ointment, which was ee ee ee ee ee eee ee eee lle far superior to the blue ointment, and which produced the same effect ; and that the hyper-oxygenated muriate of potass, more certainly heals venereal ulcers, than any preparation of mercury.

Ir may be true, that oxygen is an essential constituent of most salivating medicines ; and yet, that the activity of mercurial preparations may not depend upon this alone. Opium and seneka, it has been observed, will salivate also; but no oxygen is furnished by these articles.

Tuar the general stimulant power of oxygen is strengthened and extended, by its union with the quicksilver, appears probable ; and several considerations favour the conclusion, that it is absorbed into the blood vessels, besides the fact that no ‘separation of the two constituents is evinced by deoxygenation in the stomach.

Mercury is found to produce no sensible effects upon the salivary glands, even in the highest doses, in less than twelve hours ; but if it operated in this way, sympathetically, or as a stimulant, merely by first acting upon the surfaces of the prime viz, or of the skin, it might be expected to act sooner. This seems to support the opinion of absorption.

Dr. CutsHotm says, that oxygenous gas, obtained from mercurial oxides, almost always holdsa quantity of mercury in solution; and Chaptal saw two instances of speedy salivation, where it had been used for diseases of the lungs; a strong instance of the facility with which this form of administration a ee gy Tee Tee he ee ae eh ee inay be used. From breathing pure oxygen alone, we do not learn that salivation has ensued. |

Oxycen from the oxygenated muriate of potass ' will not salivate.

Tuat which is furnished by the nitrous acid, which is thought by some to partake of metallic properties, will uniformly salivate in hot climates.

Tue use of the metallic part of the preparations of mercury, as well as the last mentioned article, may be to convey the oxygen to all parts of the system, there to suffer a gradual evolution of this part of the compound, in an equal and uniform manner, and communicate it to every part of the body; thus acting as a powerful stimulant upon the blood vessels, particularly pervading the glands, exerting an increased action in their secerning and excretory ducts ; for the purpose of effecting which, the nature of the oxide, and the universality of its distribution, are so admirably adapted.

‘Here are several ways in which these medicines are employed, witha view of introducing them into the system; but all of them are by the skin, or the alimentary canal. By the latter, comprehending the stomach, the large intestines, (when by enema, ) and the inside of the mouth, the introduction of the medicine is, in general, easily effected ; but by the former, it is sometimes found to be not readily accomplished.

‘Tue absorbents of the skin have been thought freely to imbibe such articles, especially in a fluid form, as are presented to them, unless their peculiar qualities prevent their: admission. Modern discoveries, however, have rendered it doubtful whether such powers exist in the degree, which has been generally believed; and have proved, that without mechanical means, (forcible frictions,) it is difficult to introduce medicines in this way. This difficulty may on some occasions render it necessary for the physician to avail himself of all the auxiliary means which he can command, to effect his purposes ; and in no cases is this more urgently called for than in those where the speedy introduction of mereury is demanded by the violence of disease, and yet the irritability of the stomach is such as precludes the administering of it through that organ.