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

by Andrew Duncan

The circumstances already mentioned as claiming attention, regard peculiarities of constitution where no other disease except lues venerea can properly be said to exist. But it often happens, that the venereal disease exists in patients who are, at the same time, affected with other complaints. This affords a very extensive field for particulars to be attended to in the employment of mercury. To treat of the variety of diseases which may, in any degree, be affected by it, would be an almost endless task. In some, the mercury will be of service, as tending to a cure; many others, on the contrary, are by its use rendered evidently worse. Its influence in aggravating complaints has been said to hold, among a variety of other diseases, in cases of epilepsy, gout, and rheumatism. But on this subject attention is chiefly requisite to scurvy and hæmoptoe.

In scurvy, mercury very generally occasions a quicker progress of all the complaints. Hence, when, in such circumstances, it easily can be avoided, it is a medicine never to be employed. Cases, however, will occur, in which, although scurvy actually does exist, the use of mercury will be adviseable. In such cases, if the mercury is used slowly and cautiously, a cure of the venereal symptoms may be obtained, without rendering the scorbutic complaints much worse; but, if the mercury be suddenly thrown in, disagreeable symptoms will often arise. Of these, the principal are fœtid gangrenous ulcers, affecting the inside of the cheeks, the tongue, the palate, or the gums. It may farther be observed, that, although these are in general the consequences of the imprudent use of mercury; yet they will sometimes arise where it has been used even with the greatest caution. When they do happen, let their cause be what it will, there is, in every case, so much danger as to make it necessary to discontinue the use of mercury. Recourse is then first to be had to the employment of such means as are best calculated for the removal of scurvy. If this can once be effected, the removal of the venereal complaints may be attempted, either by the employment of other means of cure, or even by resuming the use of mercury.

Another complaint, which may be complicated with the venereal disease, and during the existence of which particular caution is necessary in the use of mercury, is hæmoptoe. That habit of body which particularly disposes to hæmoptoe is well known, and, even where the disease has never existed, can be detected by obvious marks. Many patients, after having been once attacked with hæmoptoe, are seemingly cured, and have every appearance of being restored to perfect health. Both these situations may be considered as, in a great measure, the same: In either, hæmoptoe will be induced from very trifling causes. Among others, the use of mercury has frequently been observed to have this effect. In all such cases, then, it is necessary that mercury should be used in small doses, and introduced slowly into the system.

Notwithstanding every precaution, it sometimes will happen, that hæmoptoe will arise from the use of mercury. When this is the case, it is necessary not only to abstain from the use of the medicine, but to have recourse to those means which are found to be most effectual in the cure of so dangerous a symptom. For this purpose, bleeding, refrigerants, and astringents, must be employed, as the circumstances of the patient direct. While the hæmoptoe continues, the use of mercury is not to be attempted. And although, by these means, it should happen to be removed, this medicine, unless in cases where the venereal symptoms are very urgent, is not to be ventured upon for some time, even in the most gentle forms.

We have now pointed out the principal circumstances claiming attention in the employment of mercurials, which depend either on the nature of the medicine itself, or on the condition of the patient in whom it is employed. It now only remains, then, to offer some observations with regard to the necessary regimen. What is to be said on this subject will respect either diet, temperature, or exercise; each of which may be considered in order.

It has been alledged, that mercury operates in the cure of lues venerea by acting as an antidote to the virus which produces the disease. If this is the case, it is difficult to see how any particular diet can have the least tendency to promote its operation. In adapting the diet to the medicine, then, the principal thing to be attended to, in this case, is, to order such a one as will most readily counteract those accidents which the medicine is apt to induce. The accidents chiefly to be guarded against, from the use of mercury, are those arising from its stimulant power. In diet, therefore, it is in the first place requisite, that every thing stimulant should be avoided. And then, if it can be done, such substances are to be employed as, when taken into the system, have a tendency to counteract a stimulus.

From these general principles, it is easy to see what diet is in this case to be recommended. The use of butcher-meat, and indeed of animal food in general, of wine, and of spirits of all kinds, are, from their stimulant quality, if not to be totally forbid, at least to be used sparingly. Food of every kind much salted, or highly seasoned, is to be discharged. And all such substances as would act upon the mercury, while yet in the stomach, are particularly to be avoided. The diet should be of the mildest and blandest nature, consisting chiefly of farinaceous, and mucilaginous vegetables, and of milk. The drink should be such as will quench thirst and dilute, if at the same time the patient will take what will act likewise as a demulcent, it is often preferable to such fluids as will answer only the two first intentions. For these purposes, water with toast, milk and water, barley-water, mucilaginous emulsions, or the like, may be employed with advantage.

The diet here pointed out as most suited to the nature of the medicine, is likewise best adapted to that of the complaint. As the venereal disease depends upon the introduction of a peculiar virulent matter into the system, it will scarce be imagined, that any species of diet can have great influence in the cure. But, when it is considered, that the manner in which this matter acts, is, in the first instance, by exciting inflammation, it may readily be conceived, that, from a particular diet, its action may be rendered less violent than it would be otherwise. As, for this purpose, the antiphlogistic regimen is unquestionably the most proper, it is only necessary to add to what has already been observed, that the diet above recommended should be used sparingly.

It has very universally been esteemed necessary, that those who use mercury should be kept in a warm temperature. And it is an undoubted fact, that no medicine renders the body more susceptible of injury from cold than mercury. In consequence of a sudden exposure to cold during the use of this medicine, the most fatal accidents have been observed to arise. He therefore who has taken mercury cannot be too cautious in guarding against this extreme.

But, to avoid the inconvenience which may be produced by cold, there is no necessity for running into the opposite extreme. Confinement to a very warm chamber, and the use of a number of flannels, produce a temperature which, although not so dangerous as cold, is equally improper. The cure of lues venerea, if not frustrated by the discharges thus promoted, is often retarded, and less easily obtained than it would otherwise be. After a patient has for some time been kept warm, a sudden exposure to cold is hurtful, because the parts are unable to bear the stimulus which it occasions. The same effect does not follow upon a change from a cold to a hot temperature, not only because this is seldom so sudden, but because it likewise promotes many different evacuations.