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

Materia medica and therapeutics, inorganic substances; (Volume 2) online

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continued. For eczema of the genitals, Devergie recommended a very
much weaker solution of the same; Gueneau de Mussy prefers calomel
(15 gr. to oz. of lard). For eczema about the hands, and especially for
"cracks " about the fingers and nails, an oleate of 5 per cent, strength is
said to be very efficacious (Practitioner, vol. x.). I have found an oint-
ment of hydrarg. am. chlor. gr. v. to | j. very useful for eczema capitis
et aurium after thorough removal of the crusts, also for all cases of chronic
eczema. In (non-parasitic) sycosis, mercurial ointments combined with
sulphur give the best results. In herpes preputialis, calomel is a useful
dusting powder.

Erythema Ephelides (Freckles). Many cosmetic waters owe their
efficacy to a minute proportion of sublimate, or to an albuminate of mer-
cury. M. Hardy's formula for the treatment of freckles contains lead
acetate and zinc sulphate of each 40 gr., sublimate 8 gr., with alcohol 2
oz., and distilled water 4 oz. ; it acts by slightly irritating the epidermis,
so that this exfoliates quickly. For a more decided effect Hebra uses a
stronger solution (about 4 gr. to 1 oz.), applying it for four hours till the



MERCURY. 207

skin grows red, or even is blistered, and then under soothing applications
it peels off, leaving a new surface. For ordinary erythema of the face, a
lotion containing 1 to 2 gr. in 4 oz. of almond mixture, with or without
bismuth or zinc oxide, and spirits of wine, is very useful.

Acne. The last formula is suitable for many cases of acne when sul-
phur would not be well borne; but the pustules of this disorder may often
be aborted with still more satisfactory results by means of the acid nitrate
of mercury. The apex of the pustules should be lightly touched with
this, on a glass brush, or a match point, and the drop of liquid should be
soon removed by blotting paper or sponge: some temporary irritation
may be expected.

Psoriasis. The application just described (of acid nitrate) has been
recommended also for chronic patches of psoriasis, and especially for such
as occur along the forehead at the roots of the hair, but it should be used
with great caution. The ointments of white and of red precipitate have
a certain value for psoriasis of the face, or scalp, or hands, because they
have no unpleasant color or smell, but they are seldom so efficacious as
tarry preparations. The iodides, with iodide of potassium, are also re-
commended (Rochard, Lailler).

Prurigo Chronic Lichen Pruritus. In all itching papular erup-
tions, hot dilute solutions of the perchloride are likely to give relief.
Trousseau recommends a strength of 12 gr. to the pint, and justly lays
stress upon the importance of its being used hot.

Inprurigo the ointment of ammoniated mercury either alone, or com-
bined with hydrocyanic acid, or with lead compounds, often gives relief,
and calomel ointment is a good remedy for pruritus ani, and for pruritus
of the scalp connected with chronic eczema or pityriasis.

Erysipelas Eruption of Small-pox. Evidence may be found both
for and against the use of mercurial ointment (ung. hydrarg.) in these
conditions (Stille). The application cannot be depended on for the arrest
of erysipelas, but it has some power to relieve the burning pain, and to
lessen the chances of pitting in small-pox: it certainly can prevent the
maturation of a vaccine vesicle. The late Dr. Hughes Bennett thought
highly of this treatment, and Mr. J. F. Marson says that a mercurial plas-
ter in use at the Children's Hospital, in Paris, answers well: it is a modi-
fication of the emplastrum Vigo c. mercuric, and contains 25 parts
mercurial ointment with 10 of yellow wax and 6 of black pitch; it is
most suitable for semi-confluent cases, where the patient can use a little
care, for in severely confluent attacks the application would soon be
rubbed off by the restless movements (" Reynolds' System," vol. i.).
There is also some risk of salivation, and other forms of ointment answer
equally well, so that, although I have tried mercurial preparations in such
cases, I have latterly abandoned their use.

Inflamed Lymphatics Adenitis, etc. When the parotid, the testis,



208 MATEIilA MEDICA AND THERAPEUTICS.

or the mammary gland is inflamed, gentle frictions with mercurial oint-
ment, or applications of it on lint, are suitable: in chronic superficial
glandular swellings resulting from inflammation, or especially from sy-
philis, and also to procure absorption of inflammatory products in an early
stage before suppuration has occurred, the same treatment is useful. The
5 to 10 per cent, solution of the oleate painted on night and morning is
excellent, and I have known it succeed quickly in some cases where ordi-
nary blue ointment had failed. For inflammatory and congestive condi-
tions of the uterus, but more particularly of the ovaries, a combination of
mercurial and belladonna ointments in equal parts applied externally is
sometimes useful. It has been recommended even in fibroid growths.

Serous Jffiusions Pleurisy Ilydrocele. I have not been able to
satisfy myself of distinct benefit from mercurial frictions in pleuritic or
pericardial effusions, though they have been considered useful by others:
in hydrocele in children Kock uses an ointment of the cyanide (1 part in
4), rubbing a very small quantity into the scrotum daily for three to six
weeks unless erythema supervene: in such cases I have sometimes suc-
cessfully employed, as a paint, a 2 to 10 per cent, solution of the oleate.

Goitre (Cysto- Adenoma of the Thyroid Gland). In true goitre, as
distinguished from fibroid or purely cystic enlargements, an ointment of
the red iodide of mercury succeeds, according to the large Indian experi-
ence of my colleague, Mr. Macnamara, better than any other remedy. 1
The strength he recommends is of 15 gr. to the ounce of cerate, more
than this causing unnecessary pain and soreness. A thin coating of such
an ointment should be smeared over the goitre, which should then be ex-
posed to the full rays of the sun, or at least to bright light: artificial heat
is not so effective (Frodsham: Lancet, i., 1860). Within half an hour
smarting and burning are felt, and in another hour a blister forms, which
needs to be treated oniy in the usual way. The good effects of the red
iodide continue long after this blister has healed, the tumor decreas-
ing day by day for several weeks. One application of the ointment
every two months is sufficient for the most extreme cases. Mr. Macna-
mara has often seen tumors which extended from the chin to the breasts
disappear after two or three applications; from ordinary blisters he has
never seen benefit in such cases, and the expensive iodine ointment was
found to act very slowly, compared to the mercurial preparation: he has
never seen salivation produced by the red iodide, though it is said to have
occurred in some exceptional cases.

Splenic and Glandular Enlargements. Mr. Macnamara has also
found the ointment of red iodide of mercury useful in the treatment of

1 The credit of this application has been variously ascribed to Major Holmes,
Captain Cunningham, or Grant. Mr. Macnamara's experience is based on 23,000
cases.



MERCUJRY. 209

" spleen," meaning the chronic enlargement resulting from ague or ma-
laria (ague cake): he gives at the same time "ague powders" (quinine).
At Netley this ointment forms part of the accepted treatment for such
cases, phosphates of iron, quinine, and strychnia being given internally
(Murchison: British Medical Journal, i., 1867). Dr. Andrew reports
advantage from the same ointment at St. Bartholomew's Hospital (Lan-
cet, i., 1869). Of course, in the enlarged spleen, consequent on mechani-
cal impediments to circulation, heart-disease, etc., or on blood-poisoning,
as in typhoid, or on amyloid, or other structural degenerations, mercurial
ointments are useless, and even in malarial enlargements harm may be
done by them, because splenic disease seems to render the system pecu-
liarly liable to salivation and other ill-effects of mercury. Sir Joseph
Fayrer has observed serious results from its use in splenic cachexia, with
tenderness of the organ and much debility (Medical Times, i., 1874).
Mr. Macnamara, however, as above remarked, has never seen salivation
from a judicious use of the iodide ointment, and in all chronic cases it
ought to receive a fair trial.

The ointment is equally applicable in cases of strumous enlargement
of lymphatic glands.

Inflamed Joints. In any persistent articular inflammations, whether
traumatic, gouty, or rheumatic, mercurial ointments or oleates are useful
applied with friction two or three times daily. Mr. Scott (Bromley)
earned a high reputation by his successful treatment of " white swel-
ling," chronic synovitis, etc., with a mixture of mercurial ointment, cam-
phor, soap, and cerate, applied on strips of lint firmly covered with plas-
ter strapping. Although this method is useful I commonly prefer gentle
friction with an ointment of the ammonio-chloride, beginning with a
strength of 1 part of the officinal ointment to 4 of simple cerate, and
using afterward 1 part in 8 two or three times daily. Under this simple
treatment, with rest, I have known good results, which other remedies had
failed to procure: thus, in one case of chronic inflammation of the wrist-
joint, where able surgical and hydropathic treatment had been fairly
tried, this ointment relieved more than any other means, and in several
cases of chronic disease of knee-joint already condemned to amputation,
the limb has been saved (though with stiffened joint) by this application. 1

1 Mr. Marshall introduced, for these and other cases, the use of direct compounds
of mercurial salts with oleic acid, as being u more elegant, economical, and effica-
cious." He recommends the yellow oxide to be precipitated by caustic potash from a
solution in nitric acid, and then dissolved in oleic acid according to definite propor-
tions 5 or 10 per cent, or stronger; the weaker solutions are clear, pale, yellow li-
quids, the stronger are opaque and unctuous, and, being rather irritant, may cause
pain. Mr. Marshall recommends 1 gr. of morphia to the drachm of ointment when
much pain is present, as in pleuritis, and paints 10 to 30 drops over the affected part
(Lancet, i.. 1872). Morphia dissolves readily in oleic acid, and may thus be combined
with the mercury.

Vol.. II. 14



210 MATERIA MEDIC A AND THERAPEUTICS.

Ulcerations Whitlow. In chronic indolent or suppurating- sores,
even when non-specific, the " black or yellow " lotions containing the
respective oxides are very good applications the ointment of the red
oxide is a valuable stimulant. Martin has strongly recommended blue
ointment in whitlow, rubbing it in every hour, in intervals of poulticing.
I have also used this treatment with some advantage, but the frictions
need not be so frequent. Chronic indolent ulcers of the leg, whether
syphilitic or not, often heal quickly with small doses of mercury, and lo-
tions or ointment of the same, when applied to a similar condition, pro-
duce cicatrization.

Syphilitic Ulcerations and Eruptions. It is in these forms of disease
that the efficacy of mercurial lotions and ointments is the most marked.
For condylomata, calomel with astringents is a good dusting powder, but
the acid nitrate, lightly applied, is still more effective: one application
will sometimes destroy the growths when nitric acid alone, and other
caustics have failed (Practitioner, August, 1874). The acid nitrate is
also the best agent to employ in the rare cases when it is desired to de-
stroy a chancre by caustic in its early stages. As a dressing for hard
chancre and for squamous and ulcerative forms of cutaneous syphilide,
the " emplastrum mercuriale " (Prussian form) is much commended by
Dr. Liveing. It contains metallic mercury (3 oz.), turpentine (1|- oz.),
and lead plaster (12 oz.).

For generalized syphilitic eruptions, especially those of papular or
scaly character, baths of corrosive sublimate have been recommended by
Baume, Trousseau, and others; but their proportion of oz. to each
bath I think too large: haadache, drowsiness, and sometimes colic and
diarrhosa, were produced, and the skin irritated by them. Baths contain-
ing only 10 to 15 gr. have been found very useful for syphilitic infants.

Epithelioma Lupus. Cases of epithelioma have been cured by re-
peated painting with the acid nitrate of mercury, the morbid growth being
destroyed in layers (Gay: British Medical Journal, i., 1862); and this
mode of treatment is applicable with due care in instances where operation
is not desirable. It has been used to the cervix uteri, but has sometimes
caused severe salivation, so that it has not been generally adopted:
bromine is more suitable.

Extending patches of lupus are often controlled by the nitrate, but it
is not so useful in the erythematous, as in the ulcerative and discharging
forms: its application is very painful, and should not be repeated more
than once or twice weekly, and should be followed by soothing remedies.
In chronic torpid ulcerative conditions, M. Lailler recommends an oint-
ment containing the red iodide with iodide of potassium (about 7 gr. of
each in 3 oz.), it is useful but irritant: it may be applied stronger to non-
ulcerative forms. Cinnabar is combined with arsenic in " Cosme's paste,"
which is very useful for superficial lupus patches about the face: three



MERCURY. 211

applications are usually made, for twenty-four hours each time (u.
p. 45).

Diseases of Mucous Membrane Syphilitic Throat, Tongue, etc. In
ulcerative conditions due to syphilis, gargles of " black-wash " or ap-
plications of calomel in substance are most useful: more active effects
are, however, to be obtained from painting with dilute acid nitrate 1
part in 8 or in 1C: 1 min. to 1 oz. of water is sufficient for a spray (Lyster:
Liverpool Hospital Reports, 1870). Trousseau used cigarettes for these
and for laryngeal affections. A gargle of bicyanide of mercury ( gr. to
1 oz.) is most useful when black- wash and other preparations fail.

For syphilitic and other ulcerations of the ScJmeiderian membrane,
an ointment of the gray oxide is preferred ( 3 ss. ad 3 ss.): a powder con-
taining cyanide of mercury and camphor may be cautiously used.

In Ozcena, injections of black or yellow mercurial lotion are of some
service, with powders for insufflation, containing calomel, bismuth, and
white sugar.

In Chronic Angina, good results have been obtained from the local
use of the diluted acid nitrate of mercury (1 part to 6). It has relieved
"nervous cough," and also, it is said, spasmodic asthma (Bulletin de
Therapeutique, xxiii., 1842) this would be of reflex character.

For Chronic Laryngitis and Eustachian Catarrh, Dr. Nevins has
written in favor of mercurial vapor: it may be obtained from cigarettes
made with blotting-paper soaked in a solution of nitrate (Trousseau).

In Strumous and Catarrhal Ophthalmia a lotion of corrosive subli-
mate is one of the best remedies, especially in conjunction with the inter-
nal use of the same preparation, or of calomel: 1 or 2 gr. of the sublimate
are to be dissolved in 6 oz. of water, and of this, 2 dr. with an equal part
of hot water applied three times daily. Under this lotion the conjunc-
tival redness is lessened, the corneal pustules and ulcerations of the lids
heal, while the discharge, the lachrymation, photophobia, and irritability
of the adjacent mucous membrane all diminish. In this affection is well
seen the special power of mercury to check threatening suppuration and
to heal ulceration.

In Blepharitis, when the sebaceous glands near the cilise become in-
flamed or obstructed, causing redness, crusting, and irritation, mercurial
lotions, or ointments, applied at bedtime after due cleansing, are very
serviceable. Calomel ointment is the mildest, that of the red oxide the
most energetic (B. Carter), but that of the freshly precipitated yellow
oxide, introduced by Pagenstecher, is now the most generally used ( Oph-
thalin. Review, v. ii., 115). I have been well satisfied with the effect of
white precipitate ointment diluted with three or four parts of lard, and
Haltenhoff (Geneva) prefers this.

Hordeolum (or " stye ") is often best treated by applications of the
same three or four times daily.



212 MATERIA MEDICA AND THERAPEUTICS.

Phlyctenular Ophthalmia and JTeratitis of scrofulous character have
been cured by insufflations of calomel.

THERAPEUTICAL ACTION (INTERNAL). A general effect may be ob-
tained, as we have already seen, from local applications made in several
ways by inunction, by endermic painting, or hypodermic injection, as
well as by suppository or fumigation. These methods, which will be more
fully described afterward, are utilized for mercury more than for other
drugs, yet the ordinary mode of administration is simpler, and with due
attention to the mouth and the digestion, is more satisfactory when the
conditions of the illness admit of it.

Inflammatory Diseases. From the time that Robert Hamilton de-
scribed his successful treatment of inflammation by calomel and opium
(" Duncan's Commentaries," 1764) down to perhaps twenty or thirty years
ago, mercury in some form was, in English practice at least, the almost
universal remedy both for acute inflammations, and for their results, such
as effusions, adhesions, and indurations. Trousseau described mercurials
as " les antiphlogistiques les plus puissants " more active, perhaps, than
blood-letting and Nothnagel remarks that at one time the name of any
malady ending in " itis " seemed sufficient to indicate their use. Sir
Thomas Watson, in the later editions of his classic lectures, quotes his
own earlier opinion that " mercury is a very powerful agent in controlling
inflammation, especially when acute and ' adhesive ' in character, also in
preventing exudation," but owns that this can be said no longer " it re-
quires much qualification " (5th Ed., 1871). This is perhaps the most im-
portant point in which modern experience and opinion would discredit
the therapeutical power of mercury. It is not denied that full doses can
act destructively on the blood and the tissues, though we have given some
evidence against its aplastic energy (v. p. 194), but modern clinical ex-
perience affirms that it has not great, but comparatively little power over
acute inflammatory disorders, that these often run a natural course
toward recovery independent of mercurial, or other medicinal treatment,
and that when it is pressed to a full effect convalescence is protracted by
greater ansemia and debility. (The unquestioned good results recorded
from the treatment of Hamilton, which led to its general adoption, have
been plausibly attributed to the opium rather than to the mercury.}
Sufficient account of the evils that followed was not made by our prede-
cessors, who, knowing too little of the natural history of disease, attrib-
uted all bad sequelae to it rather than to the medicines, and considered
themselves successful if, when "the disease was subdued," life at least
was saved.

We cannot, on the other hand, agree with the assertion that mercury
is never useful but always injurious in inflammation. There is evidence
of its advantage in certain conditions, though this evidence is not so con-
sistent nor so general as of its value in syphilis. It will certainly remedy



MEKCURY. 213

some of the results of inflammation, as chronic effusions in joints or lungs,
and, as Dr. Stephenson remarks when narrating such cases, no number of
instances in which the medicine has been abused, or even has failed, can
contradict the cases in which it has conferred evident benefit (Edinburgh
MedicalJournal, 1871). Dr. Ilabershon allows its value in cases of retained
secretion, dropsy, gastric disorder, as a purgative, and as anti-syphilitic,
but objects to its use in all degenerations and passive congestions, in
fevers and exhausted conditions, in diseases of mucous membrane, in
rheumatism, and all inflammations of lung, brain, etc. (Pamphlet on
Mercury, British and Foreign Review, ii., 1860). For my own part, I
still hold it useful in many chronic inflammations, whether syphilitic or
not, affecting mucous and parenchymatous tissues, and having a general
tendency to suppuration and ulceration, but I am satisfied that it should
never be pushed to salivation.

Meningitis, and Cerebral Disorders. The principal difficulty in judg-
ing of the effects of mercury in meningitis, and of the relative value of
recorded cases, lies in the uncertainty of diagnosis. Cases of cerebral
congestion, in children especially, present at first symptoms very similar
to those of simple meningitis, such as pain in the head, vomiting, injec-
tion of the eyes, excitement followed by semi-coma, pyrexia, and even
convulsion. Many years ago I usually treated such cases with minute
doses of perchloride or iodide of mercury, and, as I thought, with mod-
erately good results, but further experience has not satisfied me on this
point. Many surgeons prescribe it in traumatic cases, and believe it re-
lieves the fulness of the cerebral vessels, and although Dr. Ramskill
("Reynolds' System"), Stromeyer, and some other authorities might be
quoted as still commending mercurial influence in meningitis, the general
tendency of modern opinion is decidedly against its value. In many re-
cent text-books, in Dr. Bristowe's for instance, it is not even mentioned.
When the malady follows on febrile or eruptive diseases, or spreads from
caries e.g., in the ear-bones mercury is not likely to relieve it, and in
other idiopathic or at least non-tubercular cases, I think aconite, bella-
donna, and bromides are of more importance in the early stages, and
nourishment and perhaps iodides in the later ones. In cases presumed
tuberculous I use iodide of potassium, generally with cinchona. Dr.
Copeman, when narrating several cases of apoplexy and cerebral disorder
in illustration of the beneficial action of mercury, fully adopts the prop-
osition that it cannot prevent inflammation, but may cause absorption of
its results effusions, adhesions, etc. : he strongly advises its use, there-
fore, in all inflammations of vital organs, after the acute stage is passed
(Medico- Chirurgical Review, i., 1872). I have seen it of some service in
such cases, but many remain quite unaffected by it.

Chronic Hydrocephalus. Of this disease, Golis recorded a large
number of cures under ^ to ^ gr. doses of calomel twice daily, and mercu-



214 MATERIA MEDICA AND THERAPEUTICS.

rial inunctions of the scalp, but his results were not confirmed by other
observers. Sir T. Watson refers to two remarkable cases cured by a
mixture of metallic mercury 10 gr., fresh squill 5 gr., and manna, taken
three times daily for three weeks: it caused weakness, emaciation and di-
uresis, but not ptyalism. I have not myself seen any good result in this
condition from mercury.

Pericarditis. To treat this inflammation without mercury would, a
generation ago, have been reckoned almost criminal, and men no less
eminent than Graves and Stokes have left their emphatic testimony in its
favor the latter gave 20 gr. of calomel once or twice daily. Yet soon
afterward, Markham and Walshe began to doubt its value, and Todd de-
nied it wholly. Watson says, " I am obliged to recant my advice as to
giving mercury in acute pericarditis " (" Lectures," 1871), and Hay den
is almost alone among modern writers in still recommending calomel and
antimony (" Diseases of Heart," 1870). Waters, Austin Flint, and
Loomis have discarded mercurials, and Sibson, in his able monograph,
does not even mention them ("Reynolds' System," vol. iv.). Dr. Garrod
states that full mercurial treatment of the joint-affection in rheumatism
will not prevent pericarditis, and it would seem, therefore, scarcely likely to
arrest it after its commencement: further, as it is almost always connected
with, or dependent upon, rheumatism, its treatment should naturally be
conducted on the same principles, and as we do not now give mercury for
the main disease, why should we do so for one of its local manifestations ?
I have myself carefully watched its effects several times, and although the
bruit and other physical signs have varied during the attack, I have never
been able to satisfy myself of a definite influence of the drug upon the
malady; on the contrary, I have seen this prolonged to more than an
ordinary duration, while the gums have been sore. In subacute or chronic
cases, where effusion has occurred and is persistent, I have seen bene-



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 26 of 40)