On the treatment of syphilis and other diseases without mercury : being a collection of evidence to prove that mercury is a cause of disease, not a remedy

Preface

There is, it appears to me, a stage in the discussion of any question at which all that has to be said on the matter has been advanced by the advocates on either side ; and when the evidence ought to be read over and judgment delivered. Has this period been attained in the history of the discussion of the value of mercury in the treatment of syphilis and other diseases ? I believe so. We have at present in many of our medical schools, professors of undoubted ability, who hold precisely contradictory ideas on this subject ; and, in consequence of their theories, they make use of completely different treatment in syphilis, iritis, and in inflammatory diseases. How long is this state of things to last ? Are we to wait for another generation of observers before we decide the question ; or have we not already sufficient materials for summing up and giving our verdict ? The latter view of the state of matters is the one I have taken in this work ; and I hope that those who may read over the evidence contained in its pages, may come to the conclusion which I have arrived at, in company with some of the most illustrious professors of the day, that mercury was introduced at first needlessly into the

IV

PREFACE.

practice of medicine, as an internal remedy ; and that it now holds its place among the list of remedies solely from its having been used by the practitioners of the past, without any sufficient evidence that it is ever of the slightest service. I am well aware that many exceptions will be taken to the form of this work by those who do not agree with its conclusions. It will be said, among other things, that I have given but little evidence from my own experience, as to the truth of what I assert. To this I reply that, were it needful, I could only reiterate what has been said again and again by others, namely, that I have never seen syphilis assume any very grave secondary or tertiary forms, except when courses of mercury have been employed ; but the number of cases which L could cite would be few in comparison with the hundreds of thousands already observed. The matter, I believe, is no longer one of individual ex¬ perience, but of evidence. In short, my humble aim has been to lay, in an accessible form, before the mass of the profession, the evidence which has con¬ vinced myself; and I believe, from many recent conversations which I have had with members of the profession, that this is precisely what is wanted by those who are anxious to arrive at a conclusion on the subject.

C. R. D.

INTRODUCTORY REMARKS.

The subject of which this ^vork treats has dwelt continually in my thoughts during many years. At the outset of my investigations on this, which I consider the most important point in drug therapeutics, I felt that the utmost obscurity surrounded the subject. Though acquainted with the fact that Professor Svme and several other celebrated practitioners had abandoned mercury in treating ulcers of the generative organs and their sequelae, and knowing well, from observation, that mercury was perfectly unnecessary in the treatment of other diseases, I was not at that time aware of the over¬ whelming amount of evidence accumulated against the spe¬ cific treatment of syphilis. It is therefore with the greatest allowance for the want of acquaintance with the facts of the case in others, that I have written the following pages. I can give mercurialists the most perfect credit for the sin¬ cerity of their faith in the powers of the drug, the more willingly also, because it has been more than once my lot to find medical men, who had themselves contracted syphilis, undergoing a long and, in my opinion, most dangerous course of the remedy, for the purpose of, as they thought, neu¬ tralising the poison.

INTRODUCTORY REMARKS.

In conversing lately with a considerable number of prac¬ titioners in London, upon the subject of the administration of mercury, although in most cases I have found the faith in its efficacy very great, both as a specific in syphilis and as the best means of treating cases of acute inflammations, I have met by no means rarely some more sceptical as to the virtues of this agent ; and, indeed, it has several times been my fortune to meet with gentlemen who went as far as myself in their dislike for what they considered the most treacherous and delusive of drugs. More than once I have been informed by professional men that they have not ordered a grain of’ the mineral internally in any form for years, a confession which, as an individual, I have no hesita¬ tion also in making. For many years, too, I have watched in hospitals the practice of thq^e who give mercury, and compared it with non- mercurial treatment, and I have no hesitation for one moment in according the palm to the latter practice.

Every week, in dispensary practice, I am witness of the disagreeable effects which take place from the almost universal habit which obtains among practitioners of giving mercury in bronchitis, pneumonia, in pleurisy, in dyspepsia, &c., but most of all in syphilis. Patients, too, are continually in¬ forming us that they are bilious, after indulging in copious beer and gin drinking and tobacco smoking, or remaining from nine in the morning until ten at night in a close atmosphere, as is commonly the case with young women employed in book-folding, millinery, &c. And so dangerous a legacy has the profession been left by those who first used the word “bilious” to stand for a mass of cases of indigestion and mal-nutrition, that these patients are accustomed to swallow mercurial pills, whenever they experience the uneasiness which results from such unhealthy modes of living.

Kecent discoveries in the means of diagnosis and the extreme care which has been bestowed on this important

INTRODUCTORY REMARKS.

branch of medical science have been the most effectual blow to the empirical treatment of disease; and there are but few physicians or surgeons under forty, who now venture upon the heroic treatment of disease by bleeding, mercury, and antimony, to the extent which was so prevalent in Abernethy’s time. Bleeding from the arm, indeed, is an opera¬ tion which few students have ever seen performed during the last ten years, and has been succeeded by cupping to the extent of a few ounces, or by the application of a few leeches. But of all the delusions which have enthralled the medical mind since the days of the great Hippocrates, the belief in the utility of mercury appears to me to be by far the greatest. It is a striking example of the remark that “ experience is fallacious,” that statements regarding the effects of this drug should have remained so long unchallenged, for we have now been more than three hundred and fifty years “ under the influence ” of mercury. In the days of Celsus, Galen, &c., the mineral was forbidden by law, as a poison destructive to life, and it is only now again that some persons in Europe are beginning to believe it to be so, and it would seem that the Direction of the United States’ army medical staff are of like opinion. In Germany a large number of medical authorities are against the use of mercury ; and in France it is almost solely in syphilis that it is employed. I have, therefore, devoted the chief part of these pages to the con¬ sideration of its injurious influence in syphilis, and must refer readers to Dr. Hughes Bennett’s and to Dr. Habershon’s works, for a fuller treatise on its injurious effects in other diseases. The following letter, from the Medical Times and Gazette, June, 1863, will give an illustration of my opinions regarding the injury done by this remedy in syphilis.

et Earring don Dispensary . — Mer curio -Syphilitic Disease.

“ To the Editor of the Medical Times and Gazette.

“ Sir, — Several circumstances lead me to believe that, ere long, the propriety of administering mercurials internally in

b 2

INTRODUCTORY REMARKS.

sypliilis will come prominently before the profession for discussion. A recent debate in the Medico-Chirurgical Society and the observations of Mr. Spencer Wells disclose the fact, that the ideas of some of the leading surgeons are beginning to lose their hold upon many of the most distin¬ guished among the younger practitioners on this subject, and as it is well known that even among the mercurialists the most striking differences in practice are observable, perhaps you will kindly permit a total disbeliever in the value of mercurial treatment in syphilis a few remarks upon this subject.

“ The question of f Mercurials in Syphilis 9 is of the highest importance. On its solution, it appears to me, depends the future of mercury as a therapeutic agent. Dr. Habershon has lately done so much good service in demonstrating the injurious effect of the vaunted remedy in various diseases, that I need not here dilate upon that topic, and will only say that I concur in his disapproval of the administration of mercury in almost all diseases of the lungs, heart, abdomen, and brain. Indeed, Mr. Zachariah Lau¬ rence has lately discontinued the use of mercury in the treatment of iritis, and uses opium alone with much success ; whilst podophyllin has taken the place of mercury in the treatment of congestion of the liver.

“ But the citadel of the mercurialists is syphilis, and they cling to its administration in that disease with a tenacity worthy of a better cause. True it is, that for a time there was a defalcation from their ranks, when Fergusson, Guthrie, Bose, Hennen, &c., on returning from the Peninsula, pointed out how much better the troops got on without it ; and the treatment of more than a thousand hospital cases by Fricke, and as many by Desruelles in the Yal de Grace Hospital of Paris, without a particle of mercury, followed and nearly routed the adherents of Astruc and Hunter.

“ A reaction, however, soon took place under the general-

INTRODUCTORY REMARKS.

ship of the illustrious M. Ricord, and his partizans in London and Paris are now decidedly in the majority. I have, how¬ ever, remarked in the writings of his disciples in England a decided falling off from the zeal of the * maestro/ for whilst M. Ricord is in favour of a six-month's course of a daily dose of iodide of mercury, followed by three months of iodide of potassium, I find our most distinguished London authors ambiguous as to the length of time the mineral is to be used; and, moreover, they do not all follow M. Ricord' s method, but make use of the three modes which are as ancient as the days before Astruc, — viz., inunction, fumigation, and internal administration.

“ It has been my lot to see many severe and protracted cases of disease, produced, in my opinion, by the use of each of these three methods, and if such effects are not so fre¬ quently visible now as formerly, it is simply because prac¬ titioners are now beginning to give less and less of their vaunted specific. All who have read the voluminous evidence of Eergusson, Hennen, Ericke, Desruelles, the French and Swedish Councils of Health, Harris, &c., are well aware that symptoms such as related in the following cases never occur when patients are treated by simple rest, diet, and clean¬ liness. Besides this, the time of treatment, according to Desruelles, is not half so long when no mercury is administered.

“Case 1. Primary sore treated by mercurials — destruc¬ tion of the nose- — phthisis — death.

“On May 28, 1862, I was asked by Mr. W. Allingham, E.R.C.S., to examine the chest of a young man, age 23. History — Parents healthy ; no phthisis in the family. Patient was always in good health until infected. He is a native of London. Two years and eight months ago, whilst serving in a militia regiment in Dublin, he contracted a sore which became large and indurated. Was treated for this at the Richmond Hospital, for six weeks, with pills, to be taken

INTRODUCTORY REMARKS.

twice a day, and tlie saliva ran out. Treated again by the same gentleman, for a period of two months, for another attack of the complaint, by pills, which again made his month sore. Has not had any eruption on the body ; but sore throat. Sixteen months ago, at Aldershot, ulcers com¬ menced at the corner of the nose, and he began to cough.

“ Present condition — The alee of the nose are completely eaten away, as also the soft palate. There are marks of serpiginous ulcers over both cheeks and on lower extremities. Loud cavernous rales and cavernous breathing are heard under both clavicles. Emaciation extreme. The young man died next day.

“ Case 2. Salivation for primary sore — thirteen mis¬ carriages — iritis — necrosis of lower jaw.

“Mary H., age 46, August 1861. Twenty-one years ago patient contracted a sore from her husband, whilst pregnant. She was treated for about nine months with pills and mixture, which made her mouth sore, and had mercurial ointment rubbed into the body in various parts. She was twice salivated during the treatment. Since then she has had thirteen miscarriages and seven children born alive, of whom three died, and of the four living, all are weakly, and one is paralysed. Patient has had iritis in left eye, and is blind in that eye. Has severe pains in left side of head. Four months ago a piece of lower jaw, on left side, came away with two teeth. A large piece of the centre of the lower jaw is necrosed, although not ready for removal.

“ Case 3. Mercurial fumigation for secondaries — Extensive rupia.

“Eliza S., age 20, September, 1862.

“ History — About twelve months ago she perceived a small hard sore on the vulva, which disappeared without any treat¬ ment. About five months afterwards appeared a skin disease and sore throat. She was taken into an hospital, and had mercurial vapour-baths and pills, at bed time, for two months.

INTRODUCTORY REMARKS.

u Present condition — Patient has all over the body, and particularly on her right leg, large scabs of rupia, some of which have fallen off, and disclose large unhealthy ulcers. Is very weak and emaciated, with all the aspect of a person poisoned by the mercurio-syphilitic disease. Ordered pot. iod. as an antidote to the mercury.

“ Much triumph has been indulged in by mercurialists concerning the treatment of infantile syphilis by mercury. I regret to say I cannot share their exultation, for I have seen too many deaths of infants, when treated hv the mineral, to believe it to he a specific in this form of the disease.

“ Some time ago, sir ( Medical Times and Gazette , November, 1862), you did me the favour to publish two casesof infantile syphilis, which had recovered under the influence of careful diet, cleanliness, and chlorate of potash; since then I have treated two more cases with like remedies and like result ; and Mr. W. Allingham, F.P.C.S., has treated ten cases, without a fatal result, by chlorate of potash and hydro¬ chloric acid. Indeed, I believe that mercury, instead of always curing infantile disease, sometimes causes death; the following case is an example of this : —

“ Case 4. October 28, 1861. I saw a child, aged eleven months, covered from head to foot with a squamous syphilitic eruption, especially in the legs. The child snuffled, and the posterior cervical glands were enlarged. In other respects the child was plump and well-grown. Child to have its waist bound with a flannel band, on which a small quantity of mercurial ointment is to be smeared ; the bandage to be re¬ newed every second day.

“ November 8. Spots greatly faded, almost gone. The child looks very feeble, and has lost all its liveliness.

“ 15th. Mother came for a certificate of death.

“ After such results as the above of mercurial interference, let us look at the other picture of the disease, when treated, as all other blood poisons now are, antiphogistieally, without specifics.

INTRODUCTORY REMARKS.

6< Hennen treated 407 cases without mercury, and iritis appeared only in two. Fricke, in the Hamburg Hospital, treated more than a thousand without it, and had not one case of iritis, and never observed any bone disease during the non-specific treatment of the disease.

“ John Thompson, Liston, Syme, Hughes Bennett, Cooke, and a host of other celebrated names in England, France, and Germany, have repeatedly asserted the same as these authorities, and have one and all proved, not by assertions only, but by extensive comparative experiment, that syphilis, when treated by careful diet, rest, cleanliness, and external applications, is a disease of a very mild character.

“M. Desruelles, in his account of his treatment of the soldiers at the Yal de Grace Hospital, in Paris, says, ‘It is easy to see that the internal treatment is reduced to the greatest simplicity ; the external treatment is not more complicated, and for the one as for the other, the help of pharmacy is almost nil/

“ So strong an attachment, however, do some physicians and surgeons evince for specific treatment, that I verily believe it will require half a century before the administration of a drug, which has caused, according to the above-quoted authors, the miseries of iritis, bone disease, and ulcers of soft parts, will be abandoned, and the constitution allowed, as in the days of Flippocrates, Celsus, and Galen (for I am con¬ vinced, with M. Bicord and Mr. Travers, that the disease has always existed, although the connection between the primaries and the eruption was not perceived by Celsus, &c.), to struggle with the poison fairly, aided by attention to regimen, diet^ and cleanliness.

“ I conclude, sir, this somewhat lengthy epistle, by a quo¬ tation from Professor Hughes Bennett, a gentleman who has done more than any, to clear away the empirical from the treatment of disease, and to establish the deductive or true method of therapeutics. ‘ When we treat syphilis on the

INTRODUCTORY REMARKS.

same principles that we do scarlatina or small-pox it will prove infinitely less fatal than these disorders/

“I aim, &c.,

“ Charles Drysdale, M.D.,

“London, June, 1863.”

Some evidence, which has lately been given in courts of justice, ought to warn all of ns of the obscurity which must necessarily surround all questions in medicine, and of the advisability of maintaining a calm and unruffled temper in the discussion of medical topics.

The question of the treatment and prevention of syphilis is beset with more than ordinary difficulties. One of these 1 shall briefly advert to, as it appears still to infest some of the authors of the day. I allude to the notion that syphilis is a disease sent as a Divine chastisement of vice.

In a meeting of the Medico Chirurgical- Society, reported in the Medical Times and Gazette , February 25, 1860, Mr. Solly is reported to have said that, “ Far from consider¬ ing syphilis as an evil, he regarded it, on the contrary, as a blessing, and believed that it was inflicted by the Almighty to set a restraint on the indulgence of evil passions. Could the disease be extirpated, which he hoped it could not (marks of disapprobation), fornication would ride rampant through the land/’’

Again Dr. Druitt, in his Vade Mecum, p. 167, chap, xi., London, 1854, quotes Dr. Fergussoffis views as to the causation of the disease, in which he says “ The irregularities of man are at all times punished by the generation of diseases and loss of health ; and it would be difficult to believe in a superintending Providence, if the transgressions of divine and human law should be permitted to remain unpunished.” Dr. Druitt adds, “The author fully concurs in this opinion.”

INTRODUCTORY REMARKS.

As a contrast to this, as it appears to me, most unphilosophical view of the nature and origin of disease, I shall now quote the opinion of the great father of medicine, Hippocrates, without further comment, except to remark, that in some re¬ spects the philosophy of the nineteenth century, in London, appears, in the persons of these last-quoted authorities, to have much retrograded from that of the days of Pericles.

In his treatise On Ancient Medicine, we have this passage : — “But to me it appears that such affections are just as divine as others ; and that no one disease is either more divine or more human than another ; but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause.” I have but to add that I hope that most of us are embued with the spirit of this passage from Hippocrates, on entering upon such questions, where the feelings are apt to obscure the judgment.

Chapter I. Imperfection Oe The Empirical Mode Of Judging Of

REMEDIES.

When we regard the position of several of the branches of knowledge at the present time, we cannot fail to observe a vast difference in their approximation towards perfection. Take, for example, the science of astronomy. Here all is accurately understood, and investigations go on under well-known conditions and with no dissentient voice. None but a fanatic now denies the fact of universal gravitation as far as our own system reaches, nor disbelieves the evidence for the revolution of the planets around the sun. And yet, in days gone by, the belief in the exact opposite of these assertions was quite as prevalent, as the present conviction of the value of mercury, as supposed to be proved by experience.

Take another well-known example from natural science. It appears to have been believed for a long period of the world’s history, that reason pointed out that a heavier mass of any material would reach the ground, in falling from a height, before a less ponderous one. In chemistry, again, the supposed substance called phlogiston was brought forward to explain what happened to bodies when undergoing com¬ bustion, and, as all chemists know, the difficulty in dethroning this belief was extreme.

When we regard, however, at present, the above-named sciences, it is with a feeling of triumph that we remark, how great a power the improved methods of investigation, now so well understood in their case, has given our race over the whole of animated and inanimate nature.

When we come, however, to the more important sciences, namely, those in which the happiness of our race is most immediately concerned, how great is our discomfiture, when we perceive in what a chaos are yet involved most of the questions relating to society and to health.

I do not mean to say that much has not been discovered both in the science of society and in medical science ; but no one can fail to remark how the treatment of the first of these two branches of knowledge is considered to require hardly any preparatory study, and that the most contradictory opinions upon almost every question involved in either of these sciences prevail.

To take an example : For the last fifty years, it has been well known to all who have studied the subject, from the writings of Malthus, Chalmers, Say, James and John Stuart Mill, &c., that the cause of low wages and their consequent evil effects on the health of the poorer and ill-fed classes in European or old countries, is to be found in the over-popu¬ lation of these countries in proportion to their capital. Yet, although no person of any intelligence, who has studied this matter, looks upon this doctrine as anything but axiomatic, so great is the popular ignorance of this all-important question, that each trifling fallacy, which promises a slight augmen¬ tation of production or an inadequate emigration, is pointed to and accepted, by the masses, as a refutation of this law of man’s nature. But if fallacies are plentiful in the science of society, they are no less so in medical science. Every great man has had his school in this science, and each school has hardly survived its founder, sometimes even died out before him.

Such reflections are disheartening when we consider that, upon the state of man’s knowledge of the sciences of social and individual health, depends almost all our security, or

MODE OF JUDGING OF REMEDIES.

hopes of happiness. But when we examine the matter more narrowly, it may be observed, that the reason for the high state of perfection reached by some of the natural sciences is to be traced to the correct application of the laws of evidence peculiar to each, or, in other words, to the fact, that the method for investigating them has at length been ascertained. When this has once been accomplished for any science, the filling in of the details of that science is, comparatively speaking, a rapid affair. A host of eager inquirers pursue the beaten track, and soon an imposing edifice arises.

The methods of pursuing each of the sciences are very different, as has been shown by Mr. J. S. Mill, in his Logic. Thus, in astronomy, the method is almost entirely that of simple observation and deduction; and this, with the check of verification added, constitutes the sole available mode of investigating that science. In chemistry, again, an entirely different method is pursued ; here simple observation and experiment are the means of arriving at truth.

When we look at medical science again, we shall perceive, if we attentively consider the enormous complication of every phenomenon within its range, that the method of investi¬ gation, which is so fruitful in chemistry, is here almost barren of results ; and that our reliance must be placed in the method which has proved so signally successful in astronomy ; dis¬ covery of general laws, deductive application of these laws, and lastly verification of their operation.

It is because the science of medicine is yet pursued in the method of chemistry by so many of it votaries, that so little apparent advances are made in it ; but we may already per¬ ceive approximation to an understanding of the fallacy of this mode of investigation, in the gradually growing disbelief in the assertions of specific worshippers, and the importance now attached to the study of anatomy, physiology, pathology, and hygiene. There cannot be any question among those who are anxious to get at the natural history of different diseases, that the past empirical treatment and method has tended profoundly to darken the whole subject of pathology; so that, in describing a disease, we even yet are often unable to say what is due to the disease itself, and how much is to be ascribed to the remedy habitually administered for its cure, in the ruling practice of the day.

Now, when we are about to discuss a question, such as the treatment of syphilis, upon which such discordant opinions are held by the most eminent men in the medical profession, the question naturally strikes us, How is it possible that men of great experience, such as Lawrence, Trousseau, Copland, and other mercurialists, can hold such contradictory views to those of Syme, Hughes Bennett, Fricke, and other equally celebrated men? And, supposing either side to be right, how are they to convince their opponents? The answer, it appears to me, is, that there is a science which investigates the criteria of evidence. Let us hear, then, what the most distinguished writer on that science has to say concerning the method of arriving at truth in this very question.

After explaining that in a case where there is composition of causes, there are two methods which we may follow in investigating the effect of a given cause, either the a priori or the a posteriori method, which latter is sub-divided into the methods by experiment and by simple observation, Mr. J. S. Mill, in his Logic, vol. i., proceeds thus :

“ In order more completely to clear up the nature of these three methods, we shall select for our purpose a ease which as yet furnishes no brilliant example of the success of any of the three methods, but which is all the more suited to illus¬ trate the difficulties inherent in them. Let the subject of inquiry be the conditions of disease and health in the human body, or, for greater simplicity, the condition of recovery from a given disease ; and, in order to narrow the question still more, let it be limited, in the first instance, to this one inquiry — Is or is it not some particular medicament — mercury,

MODE OF JUDGING OF REMEDIES.

for instance — a remedy for that disease? Now, the deduc¬ tive method would set out from known properties of mercury, and known laws of the human body, and by reasoning from these, would attempt to discover whether mercury will act upon the body, when in the morbid condition supposed, in such a manner as to restore health.

“The experimental method would simply administer mercury in as many cases as possible, noting the age, sex, temperament, and other peculiarities of bodily constitution, the particular form or variety of the disease, the particular state of its progress, &c., remarking in which of these cases it produced a salutary effect, and with what circumstances it was in these cases combined.

“ The method of simple observation would compare in¬ stances of recovery, to find whether they agreed in having been preceded by the administration of mercury; or would compare instances of recovery with instances of failure, to find cases which, agreeing in all other respects, differed only in the fact that mercury had been administered, or that it had not.