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

by Andrew Duncan

Stimulants are not more dangerous in irritable habits than they are in plethoric ones; or in those in whom the force of the circulating fluids is very great. On this account, with patients in the vigour of life, evacuation is often requisite previous to the use of mercury.

These observations suggested by the age of patients using mercury, would naturally lead to the consideration of such as result from sex. From the laws of the male system, few, if any directions which will not fall under other heads, are peculiar to men; but, in the female œconomy, there are many circumstances which require particular notice.

Mercury promotes menstruation, and is apt to produce it in an excessive degree. On this account, it is always proper to intermit its use for some time previous to the flow of the menses, and during the continuance of this discharge. From the influence it has upon this evacuation, its use to any considerable degree during the term of pregnancy, is totally inadmissible. When mercury is used during nursing, it has such an effect upon the milk, that a child suckled by a woman who takes it, may by that means be cured of the venereal disease.

In different diseases, where the child is healthful, the influence of mercury on the milk would be an objection to its use, during nursing, for any particular complaints of the woman. But, where a nurse labours under the venereal disease, since in this situation she can never be supposed to suckle a child not likewise infected, as the remedy is equally necessary for both, there is no reason for delaying to attempt a cure during that period.

The different temperaments of patients, as far as they are marked by obvious signs, and have been distinguished by medical writers, afford little ground for particular observations with regard to the use of mercury. What has been said with regard to the prime of life, holds more especially with those of a sanguine habit; and the observation made concerning old age, in some degree, applies to the melancholic. But, with all temperaments, mercurials may in general be used without any peculiar preparation; and, during their use in such cases, no particular cautions are necessary which will not be suggested by other circumstances.

But, although it is necessary to say little with regard to temperaments obviously distinguishable; yet it is well known, that very great varieties in the operation of mercury arise from peculiarities in constitution. And this happens where there are no particular marks indicating such a singularity. Some constitutions are affected by mercury with very great ease, whether as acting on the alimentary canal, or as entering the system, and exerting its effects there. In cases, therefore, where the constitution of the patient is not previously known, some degree of preference is, on this account, due to the mildest forms. And, in those cases for which the more acrid ones seem best fitted, it is necessary to begin with the employment of small doses; and, if the action of these shall be found to be too violent, to have recourse to the different means of taking off sensibility. The most immediate, and perhaps the most effectual, means of removing or diminishing sensibility, is by the use of opium. But the same end may, in many cases, be obtained with equal ease, and less hazard, from the use of emollient and mild diluents; such as decoctions and emulsions, abounding with vegetable mucilage.

While some constitutions are easily affected by mercury, others, on the contrary, are acted upon with difficulty only. With these last, after the use of even a very considerable quantity of mercury, little, or perhaps no obvious action on the system can be observed. This is to be ascribed to one of two causes; either it arises from the mercury’s never having entered the system; or from its being accumulated there without proving a stimulus to any secretion. In the latter of these cases, all the effects wanted from the use of mercury may be obtained with greater ease than in any other.

The only thing, then, which is necessary in such cases is to proceed with caution, and not to throw into the system an unnecessary quantity of mercury, by which the patient may be exposed to those inconveniencies which, in a greater or less degree, accompany every increased excretion.

But it is not always an easy matter to distinguish betwixt this and the case first mentioned, in which it was alledged, that the want of obvious action arose from the mercury’s not having entered the system. When this happens, a gradual and slow procedure would not only be losing time to the patient, but allowing the disease to gain ground. The only certain mark for distinguishing betwixt these two cases, is the change produced in the morbid symptoms. In the one, the disease remains either unaltered or increased; in the other, all the symptoms are manifestly changed for the better.

If, from this test, it appear, that the want of obvious action after the use of mercury proceeds from its not having entered the system, a very different treatment is necessary from what was proposed in the former case. Here it is requisite, without loss of time, to have recourse either to a different preparation of mercury from what was formerly used, or to a different method of introducing the medicine.