The mercurial disease. An enquiry into the history and nature of the disease produced in the human constitution by the use of mercury, with observations on its connexion with the lues venerea

Front matter

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Introduction

disease is often overlooked or mistaken for some other complaint. Indeed, if I do not deceive myself, this is the principal cause of all those errors and unsuccessful cases which perplex our practice in the lues venerea ; and, I have very little hesitation in believing, that a better acquaintance with the mercurial complaint must introduce a more improved method of treating the venereal disease. I shall propose to set aside entirely the present practice of using topical mercurials to venereal wounds ; and I shall recommend no other preparation of mercury than that of its simple division by trituration in the 'form of an ointment or of a pill, except in some very, particular cases: and this will be proposed, upon the plainest conviction, that topical and saline mercurials are conducive to the disease in question.

I am not, however, forgetful of the important improvements which many excellent modern practitioners have introduced in the mode of treating the venereal disease. It was indeed from the hints and scattered remarks which I found in their works that I was first led to investigate, and to observe more attentively, the course and nature of the mercurial complaint.

The mercurial disease however, as we find it described by some modern authors in their works on the lues venerea, (for no regular or detached work on the subject has ever yet been published) is by no means so accurately marked as to give us any true idea of the complaint. To prove this,

I need only mention, that it is sometimes described, even by Mr. John Hunter, who, as I believe, had

INTRODUCTION.

Ill most considered this matter, as a disease produced from the joint effects of mercury and of the lues venerea ; at other times he mentions it as arising from mercury, merely calling forth some latent disease of the constitution into action, as scrophula, cancer, 8cc. ; and again, he describes this very disease, in another part of his work, as arising from the combined effects of mercury, of the venereal virus, and of the constitution. In other writers we find the same fluctuating opinions ; nor is there any distinction made between this specific morbid action of mercury and its common stimulating effects ; nay, it has very often been supposed to be the lues venerea in a state too inveterate to be removed by mercury. These different conjectures have of course prevented any regular mode of treatment in this complaint; the disease being regarded in each case, as one or other of the ideas just adverted to has been adopted. Mr. Hunter, indeed, in one place, even allows the mercury to be continued during the disease, till the time when the practitioner supposes the venereal virus to be subdued ; a practice which, in my opinion, would most effectually prevent its ever being removed.

It has therefore been my endeavour to prove the following particulars ; namely :

That mercury, in some instances, ceases to act as a remedy, and produces a specific action in the system, differing entirely from all its other operations, having in itself a power of suppressing, but not of curing, the venereal action : I wish also to

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evince, that this specific morbid action is produced by mercury alone, as it is often brought on in habits free from the venereal action :

That the disease is regular and uniform in its progress and termination, and that it is dissimilar in all respects to every other morbid irritation or poison, except as to its seat and the appearance of its symptoms at its commencement, in which it bears a strong resemblance to the venereal disease :

That it is never combined with other diseases, nor does mercury Avith other diseases or constitutional actions produce a variety of complaints ; but that when mercury begins to disagree with the constitution, and ceases to act in removing the venereal virus, this disagreement is constantly to be accounted for from this morbid specific action taking place ; which, if the expression may be allowed, I would wish to call the disease of the remedy. I have also endeavoured to prove further, that., by considering it in this uniform and unchangeable character, we become possessed of a fact, which is of the first importance in the practice of venereal cases ; but while it is considered under all the fluctuating designations which are given to it by most Avriters who have mentioned it, the discovery of the mercurial disease is of little or no utility.

I have in this work removed from the catalogue of anti-venereals every medicine except mercury ; as I am convinced that in Europe there is no other remedy which has the least effect in subduing the venereal irritation. Yet I have retained the use of

INTRODUCTION.

V many of the old reputed anti-venereals, such as the guaiacum, sarsaparilla, mezereon, 8cc. both in the venereal and mercurial diseases, as gentle tonics, and, when rightly managed, as active sudorifics.

Some persons may possibly look on this part of the work as unnecessary ; but, independent of the opportunity with which it furnished me of illustrating the disease, which is the immediate object of this inquiry, I was convinced that these medicines were not so completely given up in practice as anti-venereals, but that they were still resorted to in most cases of the lues venerea, supposed to be incurable by mercury, under this opinion of their powers ; and I appeal to the practice in the hospitals of this country for the truth of the opinion.

In speaking of the treatment of the mercurial disease, I trust I have laid down some rules, which, if they are strictly observed, will considerably shorten the duration of this complaint when it does actually occur.

In recommending the letting of blood in the earlier part of the cure, the supposed weakness of the patient in these cases may, perhaps, at first deter many from following this practice; but, when they have found the rapid and salutary effects which result from it, and how much more efficacious every other medicine, which is afterwards administered, becomes ; and how well the patients in these cases bear a loss of blood ; and, lastly, when they discover the diseased appearance of the blood itself, I am willing lo hope that these fears and prejudices will «oon be given up.

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first affected them ; and that, not unfrequcntly, they suffered dreadful mutilations from organic destruction. Even in more modern times, we find some practitioners who use this mineral in quantities, and upon principles hardly credible. In the surgical works of Richard Wiseman, serjeantsurgeon to King Charles the Second, when he is speaking of the cure of the lues venerea, we find him directing from twenty to thirty grains of calomel, as a dose daily, to be followed up with a few grains of turbith mineral, “ if (to use his own singular words)® after taking it four or five days, their chops do not swell:” and this he gives us as the mildest course in the slightest cases of infection.

In the works of the very learned Boerhaave, it must surprise us to find this general maxim laid down, namely, “ that the fat of the body, even to the last particle, must be drawn off in the cure of the venereal disease, for if even the least particle remains, w’e must dread a relapse;” and when he is speaking of the manner of conducting a salivation, he says, “ that if the patient spits three pints or two

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quarts in the twenty-four hours it is sufficient, — but that, if he spits less, more mercury must be given.”

In Dr. Astruc’s learned and laborious work on the venereal disease, we find that mention is made of useful ulcers in the mouth during salivation

* Wiseman’s surgical work on the Lues Venerea, Book VII. page 9.

^ Book IV. c. 7- p. 71. English edition, 4to.

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IX and he says, that “ the ulcers which are produced in the mouth by the force of the mercury are to be differently estimated according to the difference of their situation, for some are of no use, nay dangerous, others are useful and in nowise dangerous. Those are with the utmost diligence to be healed and cicatrized, since they do mischief ; on the contrary, these are to be kept open during the whole cure, since the discharge depends upon them.”

I might, with great ease, cite numerous other instances of erroneous ideas which were formerly entertained respecting the effects of mercury, but these are sufficient to evince that, the worst consequences must oftentimes have arisen from the prevalence of these ideas ; and that we have better ground, than that of a bare suspicion, for imagining that a great part of those numerous cases which we nieet with in old authors, and even in many modern ones, of incurable venereal cases, were nothing more than instances of the mercurial disease.

In the work of Mr. Lombard,* who wrote in the year 1790 on the “ Maladie Venerienne,” (vol. i. p. 223*) the practice in France is stated to be, even at that day, very often to anoint the body all over with the mercurial ointment. This practice must surely be very hazardous, and very likely to produce the mercurial morbid irritation.

* Mr. Lombard’s work was publislied at Strasburgh in the ycaf 1790, intwovols.

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from a combination of the same causes. But we ought to be on our guard, not to multiply fancifully these diseases beyond the number which really exist, by establishing every little seeming difference, as a separate disease. If we should do so, we shall {as it has frequently been the case) erroneously describe the mercurial disease under a variety of forms and combinations, and mistake it for other specific morbid actions; though, as we have before observed, it is strictly a specific complaint depending on one cause, regular in its symptoms and in its progress, and requiring a treatment not less steady and uniform, than any other well-known disease.

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In the course of this work I have made frequent citations from the writings of many excellent authors on the venereal disease ; and X have appealed to them very often, either as authorities for what I have advanced, or to explain my own opinion ; but not unfrequently because I differed in opinion from them.

The severity of regimen which I have laid down and recommended in my plan of treating the lues venerea, particularly as to the previous preparation for mercury, I hope will not be condemned, because practitioners find, that they generally succeed in curing their patients, and please them better, by a mode less strict, both as to confinement and as to preparation. For it should be recollected, that it would be unpardonable in me, had I not given that plan which appeared to me to be the surest to succeed, and which was the least exposed to accident

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XIU and interruption 5 leaving it to the judgment of the practitioner, if he should think proper, to mitigate it on favourable occasions-

I must again observe, that no superficial view of this disease will enable the practitioner to judge with precision, or to act with success. He should remember, if he is not sufficiently careful, how much he is liable to be deceived from the complication of the case, very often, with the lues venerea; and, if he is at any time doubtful whether the disease be merely venereal or mercurial, he will always act prudently in waiting a few days, or longer, before he pursues his mercury and decides upon the case, rather than hazard a hasty judgment through his alarms of the venereal virus, or from the hurry and suspicion of his patient on this point. If it should prove to be only venereal, he will have lost nothing by the delay ; but, if it turns out to be mercurial, his forbearance will have saved his patient from a disease which, when rendered severe by error in the treatment, is more tedious and formidable than the lues venerea itself. When the case is mercurial, it would be prudent to inform the patient, and make him sensible of the similarity between the two complaints. This may be done without raising a suspicion in his mind of any mismanagement, and will satisfy him that mercury ought not to be given. I may add, that it will oftentimes prevent him from seeking other advice, because he is led to believe that mercury is not given to him, when the symptoms, according to his own judgment, appear to require it. Indeed it

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will often preserve him from falling into the hands of those who may prove to have neither honesty nor judgment enough to do justice to the practitioner from whose care he has unadvisedly suffered himself to be withdrawn. I can very truly assert, that although I take care to employ decisive courses of mercury in every instance of the lues venerea, yet I always hold myself in fear of the mercurial irritation, and instantly desist from its use, when I think there is the least probability of its having commenced. By pursuing this plan, perhaps only for a few days, I observe very often that the mercury, which was before given, comes into greater effect ; and to my having this apprehension of the disease occasioned by mercury, I impute my not experiencing the same tediousness and interruptions in the cure of the lues venerea which 1 formerly found.

I shall now proceed to the proposed Inquiry.

THE

MERCURIAL DISEASE.

Section I. The Genehae History Of The Mercurial

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The desire of discovering a remedy for the lues venerea less formidable to the ^ constitution than mercury, and a natural and venial fondness for experiment and reputation, have occasionally induced medical men to try various other modes-of cure for this disease ; but the result of these inquiries has been to establish a clearer and stronger conviction that mercury is the only remedy, on which dependence can be placed. Although in most cases, in judicious hands, it is equal to our expectations, yet the best practitioners are at times much perplexed and disappointed; and this has given occasion to the erroneous idea that there are venereal cases which are irremediable by mercury, in which circumstances patients are said sometimes to fall victims to this disease ; and we find accordin almost every author who has written on

THE MERGUR I AL this subject, relations of obstinate and incurable cases of lues venerea.

Therefore, much as we are indebted to the ingenious writings of many authors, it is still very certain that the experience of three centuries has not made us sufficiently acquainted with all the effects and operations of mercury ; and that we very often mistake the morbid effects of our remedy for the progress of that disease for which it is administered. Admitting this to be true, it follows, that the further improvement in the treatment of this irksome disease must depend upon our acquiring a more accurate knowledge of those morbid symptoms which are peculiar to the operations of mercury, when it is given for any length of time, and in considerable doses.

I propose in the following pages to inquire into the history and causes of a disease peculiarly occasioned by the use of mercury, which I by no means wish to insinuate is unknown; for I shall presently produce extracts from various authors of its existence. I must however be permitted to say, that the discovery has never yet been sufficiently investigated, nor its importance in practice properly pointed out. Indeed the disease at present appears to partake of the nature of any new discovery: the fact is known, and some of the principal circumstances attending it are indirectly mentioned ; but a general and correct relation of its full extent, and of its consequences, is not to be met with.

It could not, indeed, well escape the observation

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of practitioners, that mercury oftentimes disagreed with their patients, and that, instead of removing the venereal virus for which it was given, it sometimes produced a worse disease ; yet we do not find any author who uniformly imputes this change to one true specific disease from the effects of mercury only, but sometimes to the joint effects of the mercury and of the venereal poison ; at others to mercury calling into action other diseases, as scrofula, scurvy, cancer, Xcc. or to it’s giving the diseased alteration the indefinite appellation of phagedena.

The late Mr. John Hunter, in his Treatise on the Venereal Disease (which must be allowed to contain more facts relative to the mercurial disease than can be found in any other author) very often mistakes the mercurial for the scrofulous ulcer, and imagines that there is a variety of new diseases arising from mercury, or from its effects combined with the venereal virus and the constitution, instead of considering this frequent failure of mercury in the cure of the lues venerea to be owing to one uniform diseased action produced by this mineral. Had this idea been generally adopted, I cannot help thinking that much of our practice in venereal cases would have been long ago altered and simplified ; that there would not remain a question as to the powers of mercury being at all times able to remove the venereal virus under proper management that most of the fatal and

* The lues venerea can only be said to be incurable when the disease is got to that deplorable point by neglect, that the emaciated and hectic state of the patient’s constitution forbids the use of mercury.

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IS supposed incurable cases of the lues venerea would prove to be instances of the mercurial disease, and that the anti-venereal powers ascribed to guaiacum, sarsaparilla, mezereon, 8cc. 8cc. would be considered as founded in error.

When it is considered how very active a stimulus mercury is, we are less surprised to find that it is so often the occasion of disease ; that its reception into the circulation is soon followed by an increased irritability of every fibre ; that the pulse becomes quicker and harder; and that the secretions, particularly of the salivary glands, are all much excited.

The excess of its simple stimulating powers in plethoric habits, where it has been largely given, or where the patient has been exposed to cold during its exhibition, is discovered by the common inflammatory affections which it produces. Sometimes a fever ensues, with inflammatory rheumatic swellings of the face and extremities ; at others, it produces local inflammations, suppurations, ulcerations, and even gangrene, especially about the cheeks and fauces: the intestines are very easily affected by it, and then violent fluxes with great pain and discharges of blood ensue. All these symptoms, however, are merely from an inflammatory diathesis ; they have no specific character separate from common irritation and inflammation, and they are cured by those means which are best suited to these complaints, when brought on by any other irritating cause.

Another effect of mercury is that debility which it produces after it has been employed for a great

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length of time, and in excessive doses, especially in unfavourable habits. Mercury appears to destroy the energy of the nervous system, producing weakness, tremors, palsies, fatuity, epilepsy, and mania, the most dreadful of all its bad consequences ; and indeed no part of the body is exempt from its deleterious effects. In practice, it is true, we now seldom hear of such mischiefs, except in the hands of very ignorant practitioners ; but, in the earlier writers on the venereal disease, most deplorable instances of mercurial debility are found on record.

During the use of mercury, when the liiouth has become very tender, it often happens that the dentes molares, by their pressure on the inside of the cheeks, produce ulcerations there which have a very foul, and sometimes a sloughy, appearance, and the breath has a most offensive smell: but as these ulcers arise merely from the pressure of the teeth on the inffamed cheek, the anti-venereal power of the mercury is not suspended nor diminished by them. Indeed a considerable inftamniation on the parietes of the mouth and a partial destruction of the gums, when the ptyalism is not excessive and when there is no flux from the intestines, are generally accompanied with a very rapid amendment in all the venereal symptoms.

I have thus slightly spoken of two well known diseased effects of mercury, that they may not be confounded with its specific morbid action ; for the same reason I wish to give it the title of the Chronic Mercurial Irritation-) with Ulceration ; qy

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THE MERCUIIIAL of the Mercurial Disease;^ and I shall now subjoin a general outline of the complaint and of the manner in which it commences, before I proceed more minutely in its history.

Though I consider the mercurial disease as liaole to take place in habits untainted with the venereal virus, merely by the powers of mercury only ; yet, as it is of the greatest consequence to be well known where it arises in cases of the lues venerea, and, as in very few other instances mercurial courses are carried to the same extent, I shall mostly confine myself to speak of this disease as it is connected with the lues venerea.

The mercurial disease commonly commences during courses of mercury for the lues venerea, and discovers itself by the symptoms of the complaint, for which the mineral was exhibited, becoming stationary, the mercury appearing to be no longer carrying on the same anti-venereal process which it did when first administered ; and, if it is still persisted in, we soon plainly detect a disposition in the former symptoms again to grow worse, or in the ulcerations to spread and enlarge, and we find that new symptoms begin to take place : a progress which is, in every respect, contrary to that which happens when the genuine effects of the mercury over the venereal virus proceed without interruption.

® In the course of this work I may often use the terms mercurial disease, mercurial irritation, or the morbid irritation, indiscriminately.. I therefore wish to be understood, that when I use either «f these phrases, I always allude to the specific mercurial disease.

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I therefore s:ive the title of mercurial disease to

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that effect produced by mercury, when it excites a specific state of diseased irritation in the habit, suppressing the further progress of the venereal virus, but not removing it; changing the pains, sores, and ulcerations on the body into pains and ulcerations of its own specific nature ; exciting new excoriations, eruptions, and ulcers in fresh parts, with pains, nodes, and various other affections of the tendons, periosteum, bones, 8cc. The disease is either local or general, and arises in habits where the venereal virus still circulates, or where it has first been entirely removed. It does not depend, like the lues venerea, upon the presence of any morbid animal poison. In recent cases, where the mercury is not repeated, the irritation will in a short period cease ; but when the disease has lasted a considerable time, and has been aggravated by repeated courses of the mercury, the cure becomes truly difficult, if not impossible.

The progress of this, disease is generally very slow, more so than that of the venereal; I have therefore called it the Chronic Mercurial Irritation. In some instances it has lasted many years, especially when the throat has been its principal seat, of which kind a singular case will be given hereafter. When it has appeared to be removed, it has often, on exposure to cold, or on the approach of winter, or from some irregularity in the patient, again made its appearance. I have said that its progress is mostly very sluggish; but nevertheless we meet with cases where it is quite the reverse, and in which the patient has been destroyed by it in a short time.

The exciting causes, which occasion the constitution to take on this diseased action from mercury, are probably more in number than are at present known: but the principal ones are these: 1. The faulty manner of conducting the courses of mercury; 2. The frequent use of its saline preparations; 3, The topical application of mercurials and other stimulants to venereal sores ; 4. The failure of its proper action on the mouth and on the salivary glands; and 5. The exposure to cold and wet during the use of it.

Before I enter into a more minute investigation of this disease, it will be proper in this place to examine those facts respecting it, which are mentioned bywriters on the lues venerea, as they will not only elucidate the subject, but will prove to be authorities for what I have to advance. .

In Mr. John Hunter’s Treatise on the Venereal Disease many facts and observations may be found relating to the diseases which arise during the exhibition of mercury. The most pertinent to the subject under consideration are the following. In page 280, speaking of some of the consequences of buboes, he says ; “ It sometimes happens that these sores, when they are losing or are entirely deprived of the venereal disposition, form into a sore of another kind, and most probably of various kinds. How far it is a disease arising from a venereal taint, and the effects of a mercurial course jointly, is not certain; but most. probably these two have some share in forming the disease. If this idea of it

DISEASE.

were just, it would become a specific disease and be reducible to one method of cure ; but I should suspect that either the constitution or the part hath some, if not the principal, share in it ; that is, the parts fall into a peculiar disease independent of the constitutional disease or method of cure ; for if it arose out of the two first entirely, we might expect to meet with it oftener. So far as the constitution, or the part, has a sliare in forming this disease, it becomes more uncertain what the disease is, because it must in some degree partake of the constitution or nature of the part.”

“ Such diseases make the cure of the venereal affection much more uncertain, because when the sore becomes stationary, or when the mercury begins to disagree, we are ready to suspect that the virus is gone ; but this is not always the case: the virus is perhaps only less powerful than the newly-formed disease, and as it were lies dormant, or ceases to act, and when the other becomes weaker, the venereal influence begins to shew itself again.”

Again, in page 345, “ When mercury disagrees as it were constitutionally, producing great irritability and hectic symptoms, this action or irritation is not a counter-irritation to the venereal disease, but is a constitutional irritation, having no effect on the disease, which continues to increase.”

In Chapter the 4th, page 369, speaking of the effects remaining after the disease is cured, and of the diseases sometimes produced by the cure, Mr. Hunter mentions many symptoms which will continue after the venereal virus is destroyed, as chancres, buboes, 8cc. 8cc. which will not heal, but spread and enlarge, “ especially if the inflammation and suppuration have been violent in the parts. These cases puzzle considerably; for it is difficult to say when the venereal virus is absolutely gone. In such doubtful cases, the treatment to be followed becomes more undetermined.”

“ Such complaints are more common in the tonsils than in any other part ; for we often find that while a mercurial course is going on, and the ulcer on the tonsils healing, or even healed, they shall swell, become excoriated, and the excoriations shall sometimes spread over the whole palatum molle, which renders the nature of the disease doubtful. I believe these excoriations, as well as such other appearances of disease as come on during the use of mercury, are seldom, or never, venereal. In all such cases I would recommend not to continue the mercury longer than what appears sufficient for overcoming the original venereal complaints, not considering those changes in the case as venereal.

“ It often happens that venereal abscesses will not heal up, although they have gone a certain length towards it ; for while the venereal action remained in the part, the mercury disposed that part to heal ; but under that course the constitution and part had acquired another disposition, proceeding from a venereal and mercurial irritation, affecting a particular habit of the body, or part, at the time ;

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which new disposition differs from the venereal, mercurial, and natural, being a fourth disposition arising out of all the three.

“We find also that new diseases arise from the mercury alone. The tonsils shall swell where no venereal disease has been before, the periosteum shall thicken, and also probably the bones, and the parts over them shall become cedematous and sore to the touch ; but as these complaints arise while under a mercurial course, they are not to be reckoned venereal, but a new disease, although they are too often supposed to be venereal, and on that account the mercury is pushed as far as possible. In such cases, if the complaints for which the mercury was given are nearly cured, and the medicine has been continued a sufficient time after to complete the cure of those complaints, then of course it should be left off ; and if there should be any doubt, it should be left off rather sooner than if no such complaint had taken place ; because it is probably producing a worse disease than the venereal ; and if after the cure of these complaints from the mercury, the venereal disease begins again to come into action, mercury must be given a second time, and now the constitution will be better able to bear it, especially if attention has been paid to the restoring the strength of it. Those diseases of the tonsils and periosteum I suspect to be of scrofulous origin.”