OBSERVATIONS
                                ON THE
                            USE AND ABUSE
                                  OF
                               MERCURY,
                                AND ON
                            THE PRECAUTIONS
                               NECESSARY
                          _IN ITS EMPLOYMENT_.

                            [Illustration]

                                  BY
                       A. PHILIPS WILSON, M. D.
      Fellow of the Royal College of Physicians, and of the Royal
                       Society of Edinburgh, &c.

                            [Illustration]

                              Winchester.
                  Printed and Sold by JAMES ROBBINS.

 Sold also by Messrs. CADELL and DAVIES, Strand; MURRAY, Fleet-street;
             and CROSBY and Co. Stationer’s Court, Ludgate
                             Hill, LONDON.

                            [Illustration]

                                 1805.




                           OBSERVATIONS, &c.


The following Observations are addressed to the Public, with a view,
on the one hand, to do away certain erroneous prepositions respecting
the effects of Mercury, which impede the necessary employment of it;
and on the other, to call its attention to the impropriety of an
indiscriminate use of this medicine, by which much harm is often done,
and the medicine itself brought into disrepute. The best way to effect
these purposes seems to be, to make the public acquainted with what
is really to be apprehended from an improper use of mercury, and the
circumstances in which its bad effects shew themselves; by which every
one may be enabled to distinguish these effects from such as proceed
from other causes, as well as be warned against a use of this medicine
which has become too prevalent.

Physicians will agree, that we do not possess a more valuable medicine
than mercury. Not to mention the diseases for the cure of which it was
first introduced, which, without its aid, almost uniformly prove fatal,
and in which it is almost uniformly successful, we may appeal for the
truth of this observation to its effects in some of the most dangerous
forms of scrophula, in dropsies of different kinds, in inflammations,
particularly chronic inflammations, and induration and enlargement of
the different viscera.[A]

[A] If we except worm cases, in which mercury probably acts on the
worms themselves, the various diseases in which mercury is useful,
may perhaps be reduced to the two heads of inflammation and glandular
obstruction. I believe there is nothing more erroneous than the
opinion, that mercury will occasionally succeed in almost all diseases.
This opinion has led to its employment in improper cases, and tended
consequently to bring it into discredit. I have never found it
successful except in the diseases here alluded to.

For many years after its introduction into practice, it was confined
to a few diseases. At length it occurred to physicians, that a remedy,
which in these proved so efficacious, might produce similar effects in
other cases; and such has been the success of the trial, that during
the last twenty years mercury has been coming into general use, with a
rapidity unequalled in the history of any other medicine. But the more
we are assured of its value, the more cautious we ought to be in its
employment; both because it is of the greater consequence to prevent
any prepossession against it, and because we know that there is no
active medicine which can safely be trifled with.

The prejudices which prevail against the use of mercury seem to arise
from three sources; the nature of the complaints in which it was
first employed; the uneasiness which even its salutary operation,
when carried to a certain extent, necessarily occasions; and the bad
consequences which sometimes attend an improper use of it. It is
surprising, that the first of these causes should operate against its
use; yet such is the confusion which naturally creeps into our ideas on
subjects in which we are not habitually interested, that the prejudices
of not a few originate from this cause. Of such a prejudice it is
surely unnecessary to say any thing. The other objections to the use
of mercury are of more weight.

Like all other medicines which increase the secretion by the skin,
the use of mercury tends to debilitate, and render the body more
susceptible of cold. When mercury does not encrease any other
excretion, the debility it occasions seems to be proportioned to the
degree in which it promotes perspiration; and medicines which promote
perspiration in a greater degree produce more sudden debility. We see
a degree of weakness produced by the operation of James’s powders, or
of Dover’s powders, (opium and ipecacuanha), in a few days which a
moderate course of mercury would not occasion in many weeks.

Such is the tendency of mercury to promote the secretion by the skin,
that it often runs off in this way almost as fast as it is received
into the system, particularly on its first being used; so that it
is sometimes difficult to make a sufficient quantity be retained to
produce its desired effect. Some of the good effects of mercury seem,
in a great measure, to arise from this action of it, particularly its
tendency to counteract the inflammatory disposition and to relieve
actual inflammation.

This tendency of mercury readily accounts for the bad effects of taking
cold under its influence. It is easy to conceive that the bad effects
of checking perspiration will be most felt when, to use a common
expression, the pores are most open, that is, when the secretion by
the skin is most copious; for the greater the quantity of fluid thus
discharged, the greater inconvenience is to be expected from suddenly
checking its secretion. Hence also the danger of suddenly checking
perspiration, when, by exercise or external warmth, it is rendered more
copious than usual.

Such is the admirable constitution of our bodies, that means are
provided for more or less successfully counteracting the operation
of every thing which tends to injure them. If a thorn or any other
extraneous body is introduced under the skin, inflammation and
suppuration spontaneously arise, by which the offending cause is
expelled. If a poisonous substance is received into the stomach, the
action of vomiting is frequently excited, or if it passes into the
bowels, nature still endeavours to carry it off by an increase of the
peculiar motion of the intestines, and of the secretion from their
surface; so in the case before us, the morbid fullness which would in
every instance arise, when perspiration suffers a check, is generally
prevented by the sympathy which subsists between the skin and several
other secreting organs, in consequence of which, as soon as a check
is given to the action of the former, some one of the latter, which
secrete a similar fluid from the blood, is called into more vigorous
action, and what should have passed by the skin is thrown off by the
kidneys or bowels, sometimes by the glands of the nose, throat, and
lungs, occasioning what we call a _cold_.

This substitution of one excretion for another, if I may use the
expression, is particularly apt to occur under the use of mercury, and
seems to arise from the nature of this medicine being so stimulating
that we cannot retain it in the system: if one vent is denied it, it
quickly finds another. Hence it is that people under the effects of
mercury are so subject to an increased secretion from the kidneys and
intestines, and from the glands of the mouth and throat.

It is of great consequence in most cases, in conducting a course of
mercury, as much as possible to prevent its running off, and as we
cannot wholly confine it, our plan is to direct it to that channel
thro’ which it passes off most slowly; for it is well known that
this and some other medicines, while they particularly excite any
one excreting organ, are not apt to pass off at the same time in
considerable quantity by any other. Now the channel by which mercury
passes off most slowly is the glands of the mouth, and fauces. Our
view, therefore, is generally to direct it to this channel, and the
degree in which it increases the secretion from these glands is a
sufficiently accurate measure of the quantity of mercury in the body,
as we generally find that the effects of mercury in removing disease
are proportioned to the degree in which it affects the mouth. Besides
the discharge, and consequently the debility, occasioned by the same
quantity of mercury, is less when it excites these glands, than when it
acts on the skin and bowels.

While it increases the secretion from the glands of the mouth and
fauces, it irritates and inflames them, and the inflammation it excites
when the quantity which passes in this way is great, often becoming
considerable and spreading to neighbouring parts, much uneasiness is
sometimes occasioned.

The symptoms of salivation form the chief of the bad effects, which
are peculiar to this medicine. They are indeed unpleasant, but they
are unattended with danger. It is rarely proper to induce them. A
physician may practice for several years without meeting with one
instance in which salivation is necessary; and the extent to which the
older practitioners were accustomed on every occasion to carry the use
of mercury, may be regarded as one of the greatest abuses which have
opposed the beneficial employment of this medicine. It has certainly
more than any other tended to confirm the prejudices against it. All
its good effects can in most cases be obtained by slightly affecting
the mouth, and keeping up this affection for a longer or shorter time,
according as the complaint proves more or less obstinate.

In certain formidable cases which, we have reason to believe, if left
to themselves would prove fatal, and in which more gentle means have
failed, it is proper to induce salivation. But may not a similar
objection be brought against the use of most other medicines? There
are few whose operation, is not attended with some inconvenience. How
alarming would be the operation of an emetic were we not accustomed to
see it! Violent vomiting is a symptom occasioned by some of the most
fatal poisons, yet we are easily reconciled to it when assured of its
beneficial tendency.

From what has been said, the reader will readily perceive, why a sudden
salivation is often the effect of taking cold under the operation
of mercury. We have no means of immediately checking a salivation.
Discontinuing the use of the mercury, employing gentle laxatives, and
avoiding every thing which tends to irritate the inflamed surface of
the mouth and fauces will lessen the inflammation and discharge, and by
degrees remove them.

When the mercury instead of falling on the glands of the mouth and
fauces, is thrown on the bowels in consequence of taking cold, it
is more in our power to regulate and restrain the discharge. For
the most part this affection of the bowels is a mere diarrhœa. The
griping pains which sometimes attend it seem to arise from the copious
secretion from the intestines washing off the mucus which is the
natural defence against the irritation of their contents. When this
affection is allowed to continue, and no care is taken to defend the
bowels, dysenteric symptoms sometimes shew themselves; these are most
frequently the consequence of mercury taken internally, as I shall
presently have occasion more particularly to observe.

This affection of the bowels may be induced in another way. It will
have nearly the same effect, whether the fluid, which should pass by
the skin is thrown on the bowels in consequence of the action of the
skin being checked by taking cold, or in consequence of this fluid
being directed to the bowels by any cause of irritation applied to
their surface. Hence it is, that indigestible and irritating food will
often produce such a change in the distribution of the fluids, that the
increased secretion by the skin or salivary glands, occasioned by the
mercury, shall be exchanged for that by the bowels.

When the mercury is thrown on the kidneys it passes off, as by the
skin, without uneasiness of any kind; and as in this case also, the
only bad consequences are, that the mercury, instead of acting on the
system for the cure of the disease for which it is given, is drained
from the body, and the patient is sometimes weakened by the increased
discharge. Mercury may, to a certain degree, be diverted from the
kidneys by the use of certain astringent medicines. Those which direct
it to the skin, by increasing the action of this organ, will divert it
from the kidneys; but by this we should lose, not gain, as it is thrown
off by the former more rapidly than by the latter.

In many cases the action of mercury on the kidneys is salutary, and
our aim is as much as possible, by the use of diuretic medicines, to
direct it to this channel; for it happens with respect to the kidneys,
as with respect to the bowels, that whatever tends to irritate and
increase the discharge from them, solicits the mercury to them. It is
partly in this way that it often proves a cure in various species of
dropsy.

       *       *       *       *       *

As far as we have considered the effects of mercury, its debilitating
tendency seems to arise from the evacuation it occasions. But it
debilitates in another way, which has not been sufficiently attended
to. Whatever weakens the stomach and bowels is soon felt in every part
of the system, and even medical men, as far as I can judge, are not in
general sufficiently aware of the bad effects which often arise from
the internal use of mercury. To prescribe calomel, one of the most
active preparations of this medicine, with the same freedom, and for
the same purposes, as rhubarb or senna, is in my opinion altogether a
misapplication of it.

Few things apply to the stomach and intestines a more hurtful
irritation. I have often seen temporary dysentery induced by a few
doses of calomel, and I am convinced from many cases that its habitual
or even occasional use as an aperient, however innocent it may seem at
the time, seldom fails at length to debilitate the powers of digestion,
and is often productive of still worse consequences. Calomel is
frequently given to children because it has little taste, and may be
given in small compass. But it is better to give a milder medicine,
tho’ a larger quantity may be required. Perhaps the smallness of the
quantity in which it operates is of itself a sufficient objection,
for there is no aperient which operates in very small quantity that
operates mildly, as we might have foreseen, although the trial had
not been made. For my own part, I know of few instances in which the
internal use of mercury seems proper. There are some cases where
powerful means are required to rouse the bowels to action, or a strong
stimulus applied to their exhaling vessels is beneficial; and mercury
is sometimes successfully employed internally for the removal of worms,
but in ordinary cases we can surely with equal advantage use a less
irritating medicine.

When mercury is not employed as an aperient, but for the purpose of
impregnating the system, what advantage is there in giving it by the
mouth. It seldom happens that we cannot give as much as we wish by
the skin. I have known many who were less debilitated by an ounce of
mercury taken by the skin, than by half a dram received even in the
smallest doses into the stomach.

In short, the objections to the use of mercury by the skin, seem all
to resolve themselves into the two above treated of, the debility
occasioned by an increase of some of the excretions, and a greater
susceptibility to the effects of cold.[B] While there are the same
objections to the internal use of mercury, there are far more weighty
ones, which are not the less so, because we cannot with the same
precision define them. All that we know of them is, that they chiefly
consist in a debility of the stomach and intestines, which gives rise
to the various dyspeptic complaints, flatulence, acidity, diarrhœa, and
dysentery, effects which I have so often witnessed from the internal
use of mercury, that I have for some years almost wholly abandoned it,
except in the cases above alluded to.

[B] It is unnecessary to notice a variety of groundless opinions,
respecting the effects of mercury, which prevail among the vulgar, that
it remains for ever in the system, causes a rottenness of the bones,
&c. These are similar to the prejudices which prevailed respecting the
bark for a long time after its introduction into practice, that it was
formed into masses in the stomach and bowels, from which it could never
be expelled; that nobody survived the use of it more than seven years,
&c.

The precautions suggested by what has been said will, I believe, in
every instance, prevent the bad effects of mercury, with the exception
of the symptoms of salivation, which it is now and then necessary to
induce. It will be proper to take a cursory view of these precautions.

       *       *       *       *       *

As by promoting the excretions, mercury tends to debilitate, it must be
used with caution in weak habits, and its debilitating effects should
be counteracted by the use of such strengthening medicines as are
adapted to the case in which we employ it. The debilitating effects of
mercury, however, are not such as many suppose. In a habit of ordinary
strength, a moderate course of mercury, properly conducted, produces
little debility, and I have seen many under such a course recover both
their strength and flesh. The mercury gives vigour, by removing the
cause which impairs it. With caution there is no danger in making a
trial of mercury in the most debilitated habit. In such the quantity
first employed should be too small to produce any effect whatever. Let
it be gradually increased; if, as often happens, the strength improves,
let it be continued; if the strength be much impaired by it, it should
be laid aside.

Nothing tends more to debilitate under the use of mercury, than the
unfortunate idea, that the patient should be denied the advantage of
free air and exercise. Under certain circumstances, confinement to
the house is proper. When it is necessary to induce salivation, the
patient should remain at home. The inconvenience, indeed, of going out
is sufficient to prevent it. Under even the gentlest course of mercury,
he should remain at home in damp cold weather, and after sun-set. With
these exceptions, he should be as much in the open air as his strength
will permit. It is not exposure to a cool, or even a cold air, that
checks perspiration. In a dry cold air, with a due degree of exercise,
the insensible perspiration is perhaps freer than under any other
circumstances. All that is necessary with respect to temperature is,
that it shall not be so low that the quantity of exercise, which the
patient can take without inconvenience, shall not be sufficient to keep
up a proper degree of heat.

All sudden changes of temperature, particularly that from warm to cold,
(which, notwithstanding the refinements of some modern philosophers,
may easily, I believe, be proved to be the most pernicious) are to be
guarded against. The same may be said of partial exposure to cold.
In short, it is not exposure to cold, but exposure to the causes of
what we call taking cold, that is injurious to those under the use of
mercury.

Strong exercises, I mean such as induce any degree of sensible
perspiration, and all kinds of fatigue, are hurtful.

All indigestible and irritating articles of food should be avoided
by those under the influence of mercury, both because it is proper,
under the use of all medicines which promote the excretions, to avoid
whatever debilitates, and because every thing that irritates the bowels
tends to solicit a more copious secretion from them, and thus to divert
the mercury from the channel, to which it is our aim to direct it. On
this account much wine, strong and high seasoned food, and whatever
tends to produce flatulence and acidity, are injurious.

The diet, however, should not be low, as was once recommended under
the use of mercury, which, combined with the confinement, tended to
produce the greater part of the debility attributed to the effects
of the medicine. It should be nourishing, mild, and in some degree
mucilaginous. Wine should be drank in preference to every other kind of
fermented liquor. The stronger wines should be diluted. The quantity
should be moderate, but proportioned to the patient’s habits.


                                FINIS.


JAMES ROBBINS, Printer, Winchester.




 Transcriber’s Notes:

 ――Text in italics is enclosed by underscores (_italics_).

 ――Punctuation and spelling inaccuracies were silently corrected.

 ――Archaic and variable spelling has been preserved.