However powerful bleeding and purging were in the cure of this fever, they often required the aid of a salivation to assist them in subduing it.
Besides the usual methods of introducing mercury into the system, Dr. Stewart accelerated its action, by obliging his patients to wear socks filled with mercurial ointment; and Dr. Gillespie aimed at the same thing, by injecting the ointment, in a suitable vehicle, into the bowels, in the form of glysters.
The following fact, communicated to me by Dr. Stewart, will show the safety of large doses of calomel in this fever. Mrs. M'Phail took 60 grains of calomel, by mistake, at a dose, after having taken three or four doses, of 20 grains each, on the same day. She took, in all, 356 grains in six days, and yet, says the doctor, “such was the state of her stomach and intestines, that that large quantity was retained without producing the least griping, or more stools than she had when she took three grains every two hours.”
I observed the mercury to affect the mouth and throat in the following ways. 1. It sometimes produced a swelling only in the throat, resembling a common inflammatory angina. 2. It sometimes produced ulcers upon the lips, cheeks, and tongue, without any discharge from the salivary glands. 3. It sometimes produced swellings and ulcers in the gums, and loosened the teeth without inducing a salivation. 4. There were instances in which the mercury induced a rigidity in the masseter muscles of the jaw, by which means the mouth was kept constantly open, or so much closed, as to render it difficult for the patient to take food, and impossible for him to masticate it. 5. It sometimes affected the salivary glands only, producing from them a copious secretion and excretion of saliva. But, 6. It more frequently acted upon all the above parts, and it was then it produced most speedily its salutary effects. 7. The discharge of the saliva frequently took place only during the remission or intermission of the fever, and ceased with each return of its paroxysms. 8. The salivation did not take place, in some cases, until the solution of the fever. This was more especially the case in those forms of the fever in which there were no remissions or intermissions. 9. It ceased in most cases with the fever, but it sometimes continued for six weeks or two months after the complete recovery of the patient. 10. The mercury rarely dislodged the teeth. Not a single instance occurred of a patient losing a tooth in the city hospital, where the physicians, Dr. J. Duffield informed me, relied chiefly upon a salivation for a cure of the fever. 11. Sometimes the mercury produced a discharge of blood with the saliva. Dr. Coulter, of Baltimore, gave me an account, in a letter dated the 17th of September, 1797, of a boy in whom a hæmorrhage from the salivary glands, excited by calomel, was succeeded by a plentiful flow of saliva, which saved his patient. I saw no inconvenience from the mixture of blood with saliva in any of my patients. It occurred in Dr. Caldwell, Mr. Bradford, Mr. Brown, and several others.
It has been said that mercury does no service unless it purges or salivates. I am disposed to believe that it may act as a counter stimulus to that of the miasmata of the yellow fever, and thus be useful without producing any evacuation from the bowels or mouth. It more certainly acts in this way, provided blood-letting has preceded its exhibition. I have supposed the stimulus from the remote cause of the yellow fever to be equal in force to five, and that of mercury to three. To enable the mercury to produce its action upon the system, it is necessary to reduce the febrile action, by bleeding, to two and a half, or below it, so that the stimulus of the mercury shall transcend it. The safety of mercury, when introduced into the system, has three advantages as a stimulus over that of the matter which produces the fever. 1. It excites an action in the system preternatural only in force. It does not derange the natural order of actions. 2. It determines the actions chiefly to external parts of the body. And, 3. It fixes them, when it affects the mouth and throat, upon parts which are capable of bearing great inflammation and effusion without any danger to life. The stimulus which produces the yellow fever acts in ways the reverse of those which have been mentioned. It produces violent irregular or wrong actions. It determines them to internal parts of the body, and it fixes them upon viscera which bear, with difficulty and danger, the usual effects of disease. A late French writer, Dr. Fabre, ascribed to diseases a centrifugal, and a centripetal direction. From what has been said it would seem, the former belongs to mercury, and the latter to the yellow fever.
Considering the great prejudices against blood-letting, I have wished to combat this fever with mercury alone. But, for reasons formerly given, I have been afraid to trust to it without the assistance of the lancet. The character of the fever, moreover, like that which the poet has ascribed to Achilles, is of “so swift, irritable, inexorable, and cruel” a nature, that it would be unsafe to rely exclusively upon a medicine which is not only of less efficacy than bleeding, but often slow and uncertain in its operation, more especially upon the throat and mouth.
Let not the reader be offended at my attempts to reason. I am aware of the evils which the weak and perverted exercise of this power of the mind has introduced into medicine. But let us act with the same consistency upon this subject that we do in other things.
We do not consign a child to its cradle for life, because it falls in its first unsuccessful efforts to use its legs. In like manner we must not abandon reason, because, in our first efforts to use it, we have been deceived. A single just principle in our science will lead to more truth, in one year, than whole volumes of uncombined facts will do in a century.
I lost but two patients in this epidemic in whom the mercury excited a salivation. One of them died from the want of nursing; the other by the late application of the remedy.