Observations on the Operation and Use of Mercury in the Venereal Disease

by Andrew Duncan

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?