Charles D. F. (Charles Douglas Fergusson) Phillips.

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(Virchow's Archiv, xxxii.); and Hughes Bennett, reasoning from the
experiments of the Edinburgh committee, announced, as a positive fact,
that mercury really lessened the biliary secretion in man as well as in
animals (1868). The experiments on which this physician founded his
important conclusions require a brief consideration: they were made upon
forty-one animals, and on account of difficulties in the operations, etc.,
results considered satisfactory were only obtained in nine instances in
four of these calomel was used : a permanent fistulous opening into the
gall-bladder was very carefully effected, and about fourteen days after-
ward the bile was collected on a sponge. The first dog, before taking
any drug, secreted a daily average of 82 gr. bile-fluids, and 5 gr. of bile-
solids; after taking 4 to 12 gr. calomel daily, it secreted only a daily to-
tal average of 60 gr. ; but it must be noted that the animal's condition
was much impaired, it took little food, and soon afterward died. The
second dog got smaller doses (^ gr.) every hour; the general health be-
came affected, and it soon died: the average bile-secretion was about the
same, before and after giving the drug. The third dog received some
blue pill in addition to the small doses of calomel, and the bile-average



MERCURY. 199

was diminished one-half; the animal suffered much. The fourth dog got
purgative doses, with an average bile-diminution while under their influ-
ence; on one day, however, when blue pill was given, the average was
increased (British Medical Journal, i., 1869). Such results scarcely
warranted Dr. Bennett's conclusions, which were, indeed, publicly contro-
verted by Christison, Fraser, and other members of the same committee.
Rohrig (of Kreuznach) reported that large doses of calomel slightly in-
creased the bile-secretion (Strieker's Jahrb., ii., 1873), but we may take
the more recent experiments of Rutherford and Vignal as showing, so far
as experimental research can show, that the drug does not really do so.
They proved (1) " that doses of 10 gr., 5 gr., or 2 gr., several times re-
peated, placed (without bile) in the duodenum of a fasting dog, produced
a purgative effect varying with the dose, but so far from increasing bile-
secretion, usually diminished it; (2) that there is no difference in the result
if the calomel be given in 1-gr. dose, several times repeated, mixed witli
bile and introduced into the duodenum " (British Medical Journal, ii.,
1875-76; Practitioner, December, 1879). On the other hand, the same
observers found that corrosive sublimate in doses of and T 1 ^ gr. power-
fully stimulated the secretion of bile, while it did not stimulate the intes-
tinal glands (British Medical Journal, ii., 1877). They further instituted
experiments which showed that calomel does not become changed into
corrosive sublimate to any appreciable amount under the influence of the
organic secretions. Rutherford himself notes that the experiments re-
ferred to do not prove anything as to the action of mercury on the bile-
expelling apparatus, and we may grant that they are correct without any
denial of the clinical fact that a purgative dose of calomel will increase
the amount of bile discharged by the bowel; it may do this, not neces-
sarily by a previous stimulation of the liver, but either by irritating to
unusual contraction the gall-bladder and gall-ducts, or by lessening a con-
gested condition of these parts, through the discharge induced from in-
testinal glands.

Dr. Lauder Brunton has further pointed out that the clinical fact of
calomel relieving " bilious conditions," receives from the experiments of
Schiff and Lusana an explanation not at all inconsistent with Ruther-
ford's conclusions (Practitioner, vol. xii.); these experiments go to prove
that the liver not only secretes bile, but also excretes it, separating from
the blood a part of that which (normally) circulates in it: for after
effecting biliary fistulas in animals, bile flowed at first freely afterward,
in much diminished amount, independently of any drugs. This diminu-
tion was accounted for by the passing away of bile so soon as formed,
and the consequent impossibility of its being reabsorbed from the duode-
num into the circulation, to be again excreted, for if fresh bile were
passed into the blood by intravenous or cutaneous injection, then the
amount of excreted bile was a^ain increased. Schiff further showed not



200 MATERIA MEDIC A AND THERAPEUTICS.

only that bile can thus circulate without giving rise to jaundice, but that
it probably always does so, passing from the liver to the duodenum,
thence into the blood, and so to the liver again, a portion only, more or
less changed, passing out by the faeces.

This tallies with the observation of Murchison, that " by increasing
the elimination of bile, and lessening the amount circulating in the portal
blood, mercury is a t'rue cholagogue, relieving the liver thus, more than
by merely stimulating it to increased secretion " (Lancet, i., 1874). The
green, liquid, spinach-like stools produced by calomel have been variously
attributed to intestinal irritation, to altered htematin (Golding Bird,
1845), and to subsulphate of mercury (Thudichum); it is possible that
they may contain sometimes mercurial compounds, but they certainly
often contain bile. According to Simon's analysis of the fifth stool
passed after a large dose of calomel, it was fluid, green, without faecal
odor, of acid reaction, and contained mucus and epithelial cells, fat, choles-
terin, bilin, and bile-pigments no mercury whatever (" Animal Chemis-
try," vol. ii.).

Genito-Urinary System. Women affected with mercurialism are
liable to abort (Colson, Lize), yet it is equally proved that syphilitic wo-
men should be treated with medicinal doses, for in such doses mercury
may save them from abortion (M. F. Weber, 1875). The influence on
menstruation is not constant; generally, this will be diminished, but
sometimes much increased.

Lusana found that mercurialism in fowls prevented the laying of
eggs, and Gaspard, that the vapor of quicksilver prevented eggs from
coming to maturity.

Small (therapeutical) doses exert no marked effect on the kidneys,
but we have seen that the drug is largely eliminated by those organs.
Overbeck, indeed, found leuciri and results of disintegrated albumen in
the urine of animals (Husemann), but E. R. Harvey, experimenting on
dogs, found the quantity of urine unaffected, the phosphates always di-
minished, the urea not increased beyond a normal variation (British and
Foreign Jteview, i., 1SG2). Von Bock could find no definite change in
the excretion of nitrogen or uric acid (1869). Bouchard reported a di-
minution of urea, but his patient had urajrnia (1874); and more recently,
Conty, after observation on twelve syphilitics, taking therapeutic doses
of proto-iodide, could verify no definite alteration. During pronounced
mercurialism albuminuria may occur with or without hrematuria (Pavy,
Overbeck, Kiissmaul). After death, congestion and fatty degeneration
have been found (Balogh and others); and Ollivier has pointed out the
analogy between such conditions and those produced by lead.

The albuminuria does not necessarily imply altered renal structure,
it may be dependent only upon general dyscrasia and loading of the
blood with organic debris (Gubler), but, in severe or prolonged cases, stea-



HEBCURY. 201

tosis is very probable. Bouchard has recorded two important illustra-
tions; in one case of acute mercurialism, five days after salivation had
commenced, suppression of urine occurred, and on the ninth day the pa-
tient died comatose, and a very large amount of urea was found in the
blood, almost proving that uraemia was the cause of death. We have
not details of the second case, but in both the Malpighian bodies were
found to contain, or to be changed into, mineral matter, proved to be car-
bonate of lime (Ilallopeau, p. 113). This condition is very interesting
when compared with Salkowski's results in rabbits; he injected fractional
doses of sublimate, of iodide, and of calomel, and after death, found con-
stantly lime and soda deposits in the Malpighian bodies; the urine be-
came pale and contained sugar. Cornil also found calcareous deposits,
and Kletzinski reported diabetes.

Nervous System. From the medicinal use of mercury we seldom see
definite effects on the nervous system, beyond a temporary malaise, chilli-
ness, depression, or erethism; the severe symptoms of neuralgia, tremor,
convulsion, or paralysis are met with only in persons exceptionally, or for
a prolonged period, exposed to its action, such as those who work with it
and suffer from a "chronic mercurial poisoning." A grain of calomel or
blue pill has been taken every night for more than forty years without
other than good effects apparently, for one cannot argue much from fatty
degeneration, at the age of seventy-four (Medical Times, ii., 1867). On
the other hand, tremor has developed in one night under the influence of
strong mercurial fumes (Christison), but, as a rule, the slow and con-
tinued absorption by the skin and the lungs of metallic quicksilver or its
vapor is the cause of symptoms such as those we are now considering.
Anstie pointed out that sensory nerves were sometimes affected by it,
" a selective affinity " being shown for the fifth, whence an attack of
severe and persistent facial neuralgia; but severe pain may also affect the
head generally, or all the limbs (Lancet, ii., 1872); the pains are usually
made worse by warmth; tingling or other alterations of sensibility may
be experienced; there may be partial anaesthesia or analgesia which either
varies, as in hysterical subjects, or may be permanent; abnormal sensa-
tions of cold are also described. Tremor is the most constant symptom
of chronic mercurialism: all the workmen in mercurial mines suffer from
it, and sometimes it is the only symptom apparent, there being neither
salivation, nor erethism: it commences usually in the lips and the tongue,
and soon affects the upper extremities; it is most marked, like the tremor
of sclerosis, under the influence of voluntary movements, or of fatigue;
it may exist in all degrees up to severe convulsive movement affecting
the whole body (called "calambres" at Almaden): slight cases of tremor
are curable in a few weeks; more serious ones last for months or years,
and yet the subjects continue to walk and to work. The tremors cease
during sleep, and also, it is said, during intoxication; this is an interest-



202 MATEBIA MEDICA AND THERAPEUTICS.

in"- fact, as also is the transmission of the malady by inheritance, so that
children are born in the state of tremor.

The phenomena of exaggerated action pass, after a time, into those
of paralysis, so that one or more muscles may cease to answer properly
to the will, though muscular power is retained (as in locornotor ataxy);
the extensors are often effected: sometimes the paralysis is temporary,
and of hemiplegic character; electro-muscular contractibility is preserved,
but atrophy of muscles may occur.

It remains to note the mental condition in chronic mercurialism: emo-
tional sensibility is generally heightened, the patient is timid and easily
excited, intelligence is weakened, and a delirious condition (like that of
delirium tremens) occurs in paroxysms; sleeplessness is marked. We
cannot say that true epilepsy is produced, though the convulsive attacks
may have been called by that name, but giddiness and noises in the ears,
musc<e, nausea, and tendency to fall, constitute a condition resembling
at least "petit mal." It is not likely that apoplexy can be directly con-
nected with mercurial poisoning.

With regard to the pathology of the nerve-symptoms described, Anstie
suggested that the cortical gray matter was mainly affected. Ross, in his
able paper, seems to think that an effect on the connective tissue of the
nerves would explain it (Practitioner, 1870). Mercury has been found
by analysis in the brain, but we can scarcely consider its effects to be
directly and locally poisonous to the nerve-cells: we may gain some light
from the changes discovered in cases of alcoholic or saturnine saturation
of the nervous centres, and those we find to be mainly chronic inflamma-
tion and fatty degeneration (Lancereaux, Vulpian).

Cutaneous System. We have spoken of the local irritation that may
be excited by mercurial frictions. There may be merely erythema with
much itching, or an eczematous (vesicular) rash, or even erysipelas and
gangrene (Stille). The internal use of mercury may also, exceptionally,
give rise to eruptions, of which Bazin has distinguished three forms,
" hydrargyria mitis, febrilis, and maligna," showing either a simple efflor-
escence about the thighs, the scrotum, abdomen, and axillae, or a more
intense form with vesicles, or one still more severe with general oadema
and purpuric rash. The general symptoms in such cases may be serious:'
desquamation occurs in the milder forms about the eighth or tenth day;
malignant forms (which I have never seen) may give rise to adenitis, ab-
scess, or ulceration. Occasionally, owing to idiosyncrasy, a scarlatinoid
rash may be excited by a single dose, as by f gr. of proto-iodide in a case
recorded by M. Fournier (Hallopeau): one application of acid nitrate pro-
duced the same effect, as also did a few Dupuytren's pills ( \ gr. sublimate).
If cachectic ulceration be present, the action of mercury is likely to in-
crease it, and ulcerations in the mouth especially may be caused by it:
they are more irregular and less indurated than syphilitic ulcers.



MERCUHY. 203

In exceptional cases, the secretion of sweat has been increased, it
being 1 of a clammy character and fetid odor: a general brown color of
skin or the occurrence of rupia and ecthyma has been sometimes
noted, but it is not true that eruptions really equivalent to syphilitic
eruptions are produced by mercury.

The hair and nails are said to have fallen off under its use. The teetli
are said to show the effect of the drug, especially when administered in
infancy, by a deficiency in the enamel, most marked in the first molars
(Hutchinson: Medical Times, ii., 1876, p. 242; Laycock, i., 1862, p. 450);
but this is not yet an established fact.

With regard to the tissues of the eye, we have evidence that iritis and
retinitis may be produced by the continued employment of mercury, but
a more usual condition is conjunctivitis, which occurs with the ordinary
symptoms, such as suffused redness and injection, smarting, burning, and
some excoriation and purulent secretion.

Osseous System. A form of periostitis occurs sometimes during a
course of mercury, and it has been a question whether this is due to the
remedy or to the malady (syphilis), for which it is commonly prescribed.
Pereira thinks the latter supposition correct, but Graves states that he
has seen periostitis occur in patients mercurialized for some other illness,
and who had never contracted syphilis, and to this I can add my own tes-
timony, having witnessed such an occurrence several times. The tibia,
the bones of the forearm, the clavicle, sternum, and frontal bones are
those more commonly affected, and the pains, intermittent at first, are
increased by warmth, or by changes of temperature, though sometimes
relieved by a low temperature. The articular ends of the bones are lia-
ble to be affected, and even caries may be produced.

SYNERGISTS. Agents which fluidify the blood and secretions, such as
alkalies, favor a similar action in mercury. Oxygen, dilute acids, arid
alkaline chlorides favor the transformation and absorption of metallic
mercury, and hence assist its action. Bellini, however, concluded that
these agents lessened the effect of mercurial chlorides and iodides by pre-
venting the action of carbonated alkalies upon those salts in the intestine,
and impairing the formation of double salts: magnesia he found distinctly
adjuvant, it giving rise. to a double chloride with mercury. Carbonate of
soda has been found to increase its purgative effect (Hunt: British and
Foreign Review, ii., 1852), and rhubarb, colocynth, jalap, or other purga-
tives are used to aid its action on the liver or intestine.

Alkaline iodides markedly increase the constitutional action of mer-
cury Wreden has especially shown this (Central Zeitung, 99, 1874, and
British Medical Journal}. A skin rubbed with blue ointment, and then
after an interval, and after cleansing, rubbed with iodine ointment, be-
comes much inflamed, evidently from a chemical combination (biniodide
of mercury). Milk, bromides, sulphites, and prussic acid, are also said to



204 MATER1A MEDIC A AND THERAPEUTICS.

increase the effect of mercurial compounds (Bellini), and the good effects
of mercurial treatment in syphilis are specially aided by the concurrent
use of the sulphurous waters of Aix-la-Chapelle (British Medical Journal,
i., 1874, p. 108).

ANTAGONISTS AND INCOMPATIBLES. Sulphur, especially in the form
of sulphuretted hydrogen, antagonizes the physiological action of mer-
curial compounds, whatever their therapeutical relations may be (see
above). Chlorate of potash controls, to some extent, its salivating
powers; astringents, such as alum and tannin, lessen fluxes, and tonics
and stimulants oppose mercurial cachexia.

Finely divided iron, or zinc, or gold, acts as a mechanical antidote in
cases of mercurial poisoning (Johnston: American Journal, April, 1863),
but albumen is, perhaps, more efficient: the white of one egg is calculated
to form an insoluble compound with 25 centigrammes (about 3 gr.) of
sublimate (Peschier).

Treatment of Mercurial Poisoning (Acute). By an emetic of ipeca-
cuanha, if necessary, the poison should be as far as possible removed, and
then albuminous demulcent drinks freely administered. The white and
yolks of raw eggs with milk are very suitable, or gluten may be prepared
by washing flour in a muslin bag under a stream of water, or the flour
itself may be given in a paste (Tanner). Opium may be required for the
pain and purging, and, for the mouth-condition, gargles of alum or borax.
For salivation sulphur has been strongly commended, and to promote
elimination, when the acute symptoms have subsided, the iodide of potas-
sium is to be advised. The symptoms of poisoning by corrosive sublimate
are sometimes insidious, and after evacuating the stomach a principal in-
dication is to sustain the strength. In a man under Dr. Mackey's obser-
vation, who had taken sublimate with suicidal intent and in large' quan-
tity, there were, at first, no symptoms, so that doubt was thrown on the
history given with him when first brought to the Queen's Hospital. The
stomach-pump was used, and for some days afterward he complained of
nothing but slight abdominal pain and weakness. Milk and beef-tea
were given perhaps not in sufficient quantity and stimulants were
not ordered: he died in about a week, apparently more from asthenia
than from irritant poisoning, but an inflammatory condition of the large
intestine was found.

THERAPEUTICAL ACTION (EXTERNAL). The destructive effect of mer-
curial compounds upon the lower forms of animal and vegetable life is ex-
tensively utilized in the treatment of parasitic diseases.

Phtheiriasls. When pediculi infest the head or the clothing, oint-
ments containing the red oxide, or the ammonio-chloride (white precipi-
tate), will often suffice to cure, and have the advantage of being free
from unpleasant color or odor: mercurial fumigations may sometimes be
required for the body. For the pediculus pubis, blue ointment is com-



MERCURY. 205

monly prescribed, but it is not a pleasant application, and I have seen it
produce much irritation. As in all cases when the hair is affected, de-
struction of the eggs or "nits," which are closely attached to the hair, is
important for cure, and, for this purpose, weak lotions of sublimate are
good (2 to 3 gr. to 1 pint water), or strong lotions of vinegar, followed by
the use of a dusting powder or ointment containing calomel or white pre-
cipitate.

Tinea Tonsurans Pityriasis Favus. The parasitic growths upon
which these unsightly maladies depend are destroyed by lotions contain-
ing 1 or 2 gr. of corrosive sublimate in the ounce, which should be applied
once or twice daily after cleansing: ointments containing the same, or
the ammonio-chloride, are also useful. Their curative effect, like that of
all similar remedies, is dependent somewhat on the state of the general
health in ringworm of the scalp, and in favus, but in ordinary ringworm
of the body (tinea circinata), and in pityriasis versicolor, a few applica-
tions will suffice for cure.

Dr. Alder Smith has recommended the oleates of mercury as having
more penetrating power, and records their proving curative in chronic and
obstinate cases not amenable to lotions, blisters, etc.: for children under
eight he uses a strength of 5 per cent., and, for others who can bear it, 10
per cent., mixed with acetic ether, 1 part to 7; after cutting the hair
close, thorough washing, and drying, this is rubbed into the whole scalp
regularly night and morning, a cap or turban being worn to keep any of
the preparation off the face: it is important that the head should not be
washed more than once a fortnight. Mercurial remedies should not be
used too concentrated, or over too large a surface, for fear of producing
severe constitutional effects; and it is well to remember that blistering
increases the absorptive power of the skin (New York Medical Journal,
July, 1858). Under the heading of " absorption " we have mentioned cases
in which death followed inunction of the scalp for ringworm, and would
refer again to one in which a single painting with a vesicating solution of
sublimate (gr. x. ad 3 i. ), caused salivation and death from mercurial
poisoning (British Medical Journal, 1871). I have myself seen a case
in which death resulted from the local use of a strong sublimate ointment,
and more than one case in which serious symptoms resulted.

Other Skin Diseases. In many non-parasitic forms of skin disease,
mercurials are useful locally; sometimes by a "resolvent" action or
quickening of the functions of the absorbents; sometimes by stimulating
the epithelial and other tissues also; sometimes by exciting irritation of
"substitutive character;" and in some cases by a powerful caustic effect.
In syphilitic affections they exert a "specific" power, and in many cases
their local action is supplemented by a varying amount of general action
consequent on absorption. The late Mr. Startin, perhaps an empirical
but certainly a successful practitioner in his specialty, and Mr. Naylor,



206 MATERIA MEDICA AND THERAPEUTICS.

who followed him, were accustomed to introduce mercury in some form
into the treatment of almost all their cases; and if we do not use it so
much, it is only that we have become more cautious than our predeces-
sors as to doing harm by remedies.

M. Gubler has specially drawn attention to the cure sometimes ob-
tained by mercurial treatment in very chronic skin-inflammation, such as
psoriasis and eczema, and observes that it is a last resource not to be
neglected, even if it be not easy to explain its action.

Eczema, Herpes. In the acute inflammatory stages of eczema mer-
curials are usually unsuitable as being irritant, but Dr. Spender speaks
highly of the use of lotio hydrarg. nigra in eczema rubrum: he adds gly-
cerin, and applies it fresh three times in twenty-four hours, without oiled
silk (British Medical Journal, i., 1878, p. 286). In subacute and chronic
stages, with thickening from infiltration of the cellular tissue, moderate
crusting, scaling, and dryness of skin, mercurial ointments are very ser-
viceable; that of the red oxide often irritates, even at this stage, and that
of the ammonio-chloride, diluted 1 in 4 or 8, is more generally suitable:
Niemeyer specially commends it for chronic eczematous patches on the
face. When there is more than average secretion or irritation, better re-
sults are obtained by a combination with equal parts of lead, or of zinc
ointment, and a formula much used for eczema capitis at the Skin Hos-
pital is the following: I. Plumbi acet. gr. x. ; zinci oxidi, hydrarg. sub-
chlor., ung. hydrarg. nitrat., aa gr. xx. ; olei palmse purif. fl. f ss. ; adipis
recentis ss., misce: such ointments are useful in the chronic general
eczema of childhood especially.

For eczema mammae, which is often very obstinate, Hebra uses sub-
limate-lotions (1 in 120), but they require great care if any lactation is



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 25 of 40)