The condition of the patient ought always to be considered previous to his entering upon a course of mercury in any form. It would be equally rash and dangerous to administer mercury to a person labouring under any violent acute disease, as a putrid fever, pleurisy, peripnuemony, or the like. It would likewise be dangerous in some chronic cases; as a slow hectic fever, or the last stage of a consumption. Sometimes, however, these diseases proceed from a confirmed lues; in which case it will be necessary to give mercury. In chronic diseases of a less dangerous nature, as the asthma, the gravel, and such like, mercury, if necessary, may be safely administered. If the patient’s strength has been greatly exhausted by sickness, labour, abstinence, or any other cause, the use of mercury must be postponed, till by time, rest, and a nourishing diet, it can be sufficiently restored.
Mercury ought not to be administered to women during the menstrual flux, or when the period is near at hand. Neither should it be given in the last stage of pregnancy. If, however, the woman be not near the time of her delivery, and circumstances render it necessary, mercury may be given, but in smaller doses, and at greater intervals than usual; with these precautions, both the mother and child may be cured at the same time, if not, the disorder will at least be kept from growing worse, till the woman be brought to bed, and sufficiently recovered, when a more effectual method may be pursued, which, if she suckles her child, will in all probability be sufficient for the cure of both.
Mercury ought always to be administered to infants with the greatest caution. Their tender condition unfits them for supporting a salivation, and makes it necessary to administer even the mildest preparations of mercury to them with a sparing hand. A similar conduct is recommended in the treatment of old persons, who have the misfortune to labour under a confirmed lues. No doubt the infirmities of age must render people less able to undergo the fatigues of a salivation; but this, as was formerly observed, is never necessary; besides, we have generally found that mercury had much less effect upon very old persons, than on those who were younger.
Hysteric and hypochondriac persons, and such as are subject to an habitual diarrhœa or dysentery, or to frequent and violent attacks of epilepsy, or who are afflicted with the scrofula or the scurvy, ought to be cautious in the use of mercury. Where any one of these disorders prevails it ought either, if possible, to be cured, or at least palliated, before the patient enters upon a course of mercury. When this cannot be done, the mercury must be administered in smaller doses, and at longer intervals than usual. The most proper seasons for entering upon a course of mercury, are the spring and autumn, when the air is of a moderate warmth. If the circumstances of the case, however, will not admit of delay, we must not defer the cure on account of the season, but must administer the mercury; taking care, at the same time, to keep the patient’s chamber warmer or cooler according as the season of the year requires.
The next thing to be considered is the preparation necessary to be observed before we proceed to administer a course of mercury. Some lay great stress upon this circumstance, observing that by previously relaxing the vessels, and correcting any disorder which may happen to prevail in the blood, not only the mercury will be disposed to act more kindly, but many other inconveniencies will be prevented.
We have already recommended bleeding and gentle purges, previous to the administration of mercury, and shall only now add, that these are always to be repeated according to the age, strength, constitution, and other circumstances of the patient. Afterwards, if it can be conveniently done, the patient ought to bathe once or twice a day, for a few days, in lukewarm water. His diet, in the meantime, must be light, moist, and cooling. Wine and all heating liquors, also violent bodily exercise, and all great exertions of the mind, are carefully to be avoided.
A proper regimen is likewise to be observed by such as are under a course of mercury. Inattention to this not only endangers the patient’s life, but often also disappoints him of a cure. A much smaller quantity of mercury will be sufficient for the cure of a person who lives low, keeps warm, and avoids all manner of excess, than of one who cannot endure to put the smallest restraint upon his appetites; indeed, it but rarely happens that such are thoroughly cured.
There is hardly any thing of more importance, either for preventing or removing venereal infection than cleanliness. By an early attention to this, the infection might often be prevented from entering the body; and where it has already taken place, its effects may be greatly mitigated. The moment any person has reason to suspect that he has received the infection, he ought to wash the parts with water and spirits, sweet oil, or milk and water; a small quantity of the last may likewise be injected up the urethra, if it can be conveniently done. Whether this disease at first took its rise from dirtiness is hard to say; but wherever that prevails the infection is found in its greatest virulence, which gives ground to believe that a strict attention to cleanliness would go far towards extirpating it altogether.[[12]]
[12]. I have not only seen a recent infection carried off in a few days by means of cleanliness, viz., bathing, fomentations, injections, &c., but have likewise found it of the greatest advantage in the more advanced stages of the disease. Of this I had lately a very remarkable instance in a man whose penis was almost wholly consumed by venereal ulcers; the matter had been allowed to continue on the sores without any care having been taken to clean them, till, notwithstanding the use of mercury and other medicines, it had produced the effects mentioned. I ordered warm milk and water to be injected three or four times a day into all the sinuous ulcers, in order to wash out the matter; after which they were stuffed with dry lint to absorb the fresh matter as it was generated. The patient at the same time took every day half a grain of the corrosive sublimate of mercury, dissolved in an ounce of brandy, and drank an English quart of the decoction of sarsaparilla. By this treatment, in about six weeks, he was perfectly cured; and, what was very remarkable, a part of the penis was actually regenerated.
Dr. Gilchrist has given an account of a species of the lues venerea which prevails in the west of Scotland, to which the natives give the name of Sibbins or Sivvins. The doctor observes, that the spreading of this disease is chiefly owing to a neglect of cleanliness, and seems to think, that by due attention to this virtue, it might be extirpated. The treatment of this disease is similar to that of a confirmed lues or pox. The yaws, a disease which is now very common both in America and the West India Islands, may also be cured in the same manner.