Andrew Duncan

“ Theory is natural to the human mind; and those who are accustomed to think cannot be satisfied without assigning a reason for every phænomenon which falls under their observation. Theory by no means precludes observations: On the contrary, it leads to 6a more minute attention to facts; and in this way opinions, of themselves ill founded, have often given rise to useful discoveries in practice. For these reasons, in treating of mercury in the venereal disease, I have esteemed it necessary to begin with some observations on its operations. ”

“ In such circumstances, however, by mercury the venereal disease is cured, by these other evacuants it is not. And farther, where the cure of lues venerea has been retarded by a salivation occurring early, or where no cure has taken place after salivation has been continued for a considerable time, there is every mark of a much higher degree of inanition than when the disease has been removed by mercury without any sensible evacuation. There can remain no doubt, then, that the cure of lues venerea is by no means in proportion to the evacuation which it produces. ”

“ In favour of the supposition, that mercury, in reality, possesses a power of rendering the venereal virus inactive, it may be observed, that an action in this manner is at least conceivable; and that it is analogous to what we have an opportunity of observing in other cases of nature. Many substances which possess the most active powers in nature, have these entirely destroyed, or totally altered, from combination with other substances. ”

“ The stimulant power of corrosive sublimate is so great that it is never, even for external purposes, used in a solid form. But the aqua phagedænica of the Edinburgh College, which is a solution of it in lime-water, is a mercurial preparation which has often been used externally, both in venereal and other foul ulcers. This form, however, contains so large a proportion of the mercury, that it is by much too stimulant for the greatest part of sores. ”

“ 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. ”

“ Here, therefore, as in habits naturally disposed to salivation, the presence of any quantity of mercury in the system will be very transient, and a salivation occurring will often frustrate the cure to be expected from it.
Calomel, from its general stimulant power, may readily be supposed to affect the intestines more considerably than the milder mercurial preparations; and, in fact, it is found, that, in many cases, it much more readily excites looseness than they do. ”

“ From what occurs in many morbid cases, we have every day evident proof of the insufficiency of any discharge for producing a cure of the venereal disease. Lues venerea often exists at the same time with diseases in which an increase of natural evacuations 49takes place. None of these diseases, whether the evacuation happens by the salivary glands, as in small-pox, by stool, as in dysentery, or by the skin, as in intermittents, have ever been found to break its force, much less to produce a perfect cure. ”

“ Other stimuli which operate more immediately and more strongly, have by no means an equal effect. When mercury stimulates in the highest degree, the best consequences are by no means observed to arise from 75it. And it often produces a cure from topical application, where no effects of its operating as a stimulus can be observed. From these facts, it is evident, that the cure of venereal ulcers, produced by the topical application of mercury, can by no means be referred to its stimulant power. ”

“ Few diseases are at present more common than lues venerea. For its cure, mercury is a medicine which is almost universally employed; and the efficacy with which it operates has long been confirmed by unquestionable experience. But the successful employment of mercury in 2this disease requires very particular attention; and it is to be regreted, that, while many suffer from the distemper, not a few fall victims to what is used as the remedy: All therefore that has hitherto been said on this subject by no means supersedes farther attempts to improvement. ”

“ The effects of mercury on the human system in a sound state are very various. When mercury, in its crude state, is introduced by the mouth into the alimentary canal, it passes off by stool, without producing any effect. It has indeed been alledged, that in this state, in some morbid affections, it may be useful in removing obstructions by its weight. But it is to be remembered, that, in a great part of its passage through the intestines, it rises in opposition to gravity, and that 17it is very apt to divide in such a manner as to make its way through very small openings. ”

“ If, on the other hand, the venereal poison be supposed to exist only as a noxious matter in the body, when collected at particular parts, it is equally difficult to conceive, how evacuation from its nature should produce a cure. It never has been observed, that mercury particularly encreases the discharge by those parts where the venereal matter appears actually to exist. ”

“ Mercury may be rendered saline by being united with other acids as well as the nitrous. These likewise are, in general, active preparations; but they do not possess a caustic power, at least in so high a degree as the nitrous preparations. Among the most active of the other saline preparations, are those prepared with the muriatic acid, and especially the corrosive sublimate. This is a mercurial preparation which, in many cases, may be employed to act immediately on parts affected by the venereal virus ”

“ 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. ”

“ That mercury, when it is exhibited in such a manner as to be capable of conjunction with the venereal matter, has a power of rendering it inactive, is an assertion, which, it might be imagined, could be put to the test of experiment. ”

“ Perhaps the most common form of exhibiting mercury in this place, with 127a view of entering the system, is that of the mercurial pills. These, when properly prepared, seem, in most cases, to be justly entitled to the preference, which is here so frequently given them. The mercury, in this preparation, is rendered active by the same means, and is in the same state as in the preceeding one. Its operation likewise in this form is very analogous to what it is in the one formerly mentioned. It is here equally apt to salivate as in the form of unction. ”

“ 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 170blandest 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. ”

“ On the other hand, if the intestines are not very irritable, it will be particularly serviceable, in many recent cases, in which a speedy action of mercury is adviseable; and, in those where the venereal virus has not yet made its way into 139the circulating system, but is detained in the lymphatic, or in the mucous glands. From its sudden evacuant power, it may likewise be of great service where mercurials in the venereal disease are intended to be conjoined with an antiphlogistic course, or to make a part of it. ”

“ But this imperfect state of theory, in place of being any objection to its utility, is an additional inducement to continue, with unremitting ardour, a pursuit in which so much still remains to be done. 5It is by unwearied assiduity alone that improvement can be expected in any art. The imperfection of theory, then, can be no argument for discontinuing farther attempts to render it more perfect.
Theory in medicine is principally despised by two sets of practitioners, the ignorant and the lazy; the last are unwilling, and the first are unable, to acquire the knowledge of it ”

“ 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.
158The 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 ”

“ But it affords at least some chance of arriving at truth, that, in the present age, it is never esteemed criminal to differ even from the highest authorities: On the contrary, those whose authority 7should deservedly have the greatest weight, are unwilling that any farther deference should be paid to their opinion than arises from conviction. He therefore who imagines, that an ill-grounded opinion is generally received, has nothing to restrain him from a candid inquiry. But arguments adduced in favour of any opinion will have little weight, if another be previously received as true. ”

“ Mercury is often meant to act in the venereal disease, without any general affection of the system, or without entering the mass of circulating fluids, where it cannot come into immediate contact with the affected parts. ”

“ Of the accidents most to be guarded against, not a few are, in a great measure, the natural consequence of the medicine itself. Although, in some constitutions, and with particular treatment, they will arise more readily than in others; yet they may happen in any constitution, and with any treatment. ”

“ From violent exercise, the patient is liable to the same inconveniencies as from a hot temperature, and frequently to all the dangers resulting from a sudden exposure to cold. Of exercise, as of temperature, it may be observed, that it should be so regulated, as to support a proper 175balance among the different excretions. For this purpose, when the patient is abroad, moderate exercise is in general requisite. For the same reason also, even when the patient is confined to his chamber, such moderate exercise as can there be obtained, is for the most part proper. ”

“ Many practitioners, indeed, hold every thing that is in the least theoretical, in great contempt. They 3alledge, that a physician possesses all the knowledge requisite in medicine, who is acquainted with particular remedies which will infallibly cure particular diseases. Could such remedies be discovered, their reasoning would indeed hold good; and medicine, which, of all arts, is in reality the most difficult, would be the easiest. ”

“ Many of those mercurials, which have 18not such an influence upon the stomach as to produce vomiting, upon entering the intestinal tube, act as purgatives. This effect of mercurials is, among other preparations, particularly remarkable on the use of the Coralline mercury, Prince’s powder, or calomel.
Mercurials, which fail in producing either purgative or emetic effects, frequently act as diaphoretics. Diaphoresis, or even a profuse sweat, is often the consequence of many of the mercurials already mentioned. ”

“ Independent of that affection of the gums and mouth, which, for the most part, is the forerunner of salivation, it sometimes happens, even where no particular exposure to cold can be blamed as a cause, that the whole head is remarkably swelled. ”