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

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

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fit from small doses of sublimate or gray powder and mercurial applica-
tions locally, but when the effusion is very large, the pulse feeble, and
cardiac paralysis threatening, any excess of mercury must be carefully
avoided (Nothnagel).

Endocarditis. In rheumatic endocarditis, on account of the still
more serious issues involved in exudation and adhesion, more advocates
are to be found for the use of mercury in the hope, at least, of controlling
such results. I cannot dogmatize on this question, but I place more con-
fidence in opium and rest.

Pleuritis. Fuller and Walshe may be named among modern advo-
cates of mercurial treatment in pleurisy, but for the acute stage I cannot
see its advantage, since aconite, salines, belladonna, or morphia, with
suitable local applications, give usually all the good results that can be
expected from medicines. When effusion has occurred, however, I be-
lieve that mercury may be of considerable service in stimulating the ab-



MERCURY. 215

sorbents; and in some cases, when hectic has set in and there have been
signs of commencing' pus-formation, small doses of corrosive sublimate
have seemed to me advantageous. I have also noted benefit from this
medicine in pleuritis occurring in puerperal women, and a similar obser-
vation is recorded by Nothnagel. In no case should it be pushed to the
production of salivation or anjemia.

Peritonitis. Velpeau was the great advocate for a thorough mercu-
rial treatment of this inflammation, and by enormous doses of calomel
used concurrently with inunctions, he expected so to alter the blood in a
few hours as " to prevent its furnishing the elements of a severe inflamma-
tion." Trousseau adopted for some time a similar method, for which he
substituted later that of Dr. Law, giving minute doses frequently.
Without accepting Velpeau's theory, it may be said that mercurial treat-
ment or rather calomel with opium has been less completely aban-
doned in this inflammation than in many others. Watson certainly says
" he is doubtful if it has ever done good, while if it purge it must do
harm," but I believe that small doses of calomel or of sublimate (y-J-g- to
g^o gr.) have conduced to the recovery of some of my cases of acute and
" idiopathic" peritonitis. I have generally given them every one to three
hours alternately with aconite, and used opium as required for relief of
pain. In localized forms of peritonitis, occurring, for instance, after per-
foration, or from peri-typhlitis, opium is the most important remedy.

Pneumonia. In the early stages of acute pneumonia, formerly
treated by calomel and antimony, I cannot recommend mercurials, but
the time for using them with advantage is when secondary fever arises,
and there is reason to fear purulent degeneration. So far as I can judge,
they have seemed to exert some power in preventing this, for certain
cases of the kind have improved on commencing the use of sublimate,
and others have relapsed on its omission. In pleuro-pneumonia, with
copious effusion, the sama remedy is still more clearly indicated, and in
chronic interstitial pneumonia it sometimes has excellent effect. Some-
times a syphilitic or strumous deposit occurs in the lung, rendering it par-
tially solid, and giving the physical signs of a pneumonia, and these de-
posits, especially when of the former nature, seem to " melt away " under
the moderate action of mercury: but careful diagnosis of such cases is
required, for in true tubercular deposit the drug is injurious. Graves
speaks highly of mercury " in scrofulous inflammation of the lung."

^Bronchitis. In acute cases, with much congestion of mucous mem-
brane and scanty expectoration, small doses of perchloride are often use-
ful. In certain cases narrated by Thorowgood, blue pill with squill was
given with apparent advantage, when there was " severe cough at night,
pyrexia with loaded urine, dyspnoea, some lividity of lips, difficult scanty
expectoration, with rales, and perhaps impaired resonance " (Practitioner,
i., 1878) i this treatment is more suitable for robust adults than for the



216 MATERIA MEDIC A AND THERAPEUTICS.

aged. In catarrhal bronchitis passing into pneumonia, frictions of the
chest with oleate of mercury are said to be useful.

Coryza. In ordinary coryza, especially when there is much sneezing,
I have often found small doses of gray powder cure more quickly than
any other remedy. Catarrh affecting the Eustachian tube is also well
treated in the same manner.

Diphtheria Croup (Laryngeal Diphtheria). Stille, after giving
many authorities in favor of the mercurial treatment of diphtheritic dis-
ease, says himself " that it appears urgent that the system should be
brought under mercurial influence as speedily as possible," and following
Albers, he recommends gr. of calomel every hour, and a scruple of mer-
curial ointment to be rubbed at intervals into the thighs. Trousseau,
finding that the direct application of calomel to external diphtheritic sur-
faces modified favorably their condition, recommended its use by insuffla-
tion, or by allowing it to mingle slowly with the saliva; this has not,
however, given much result. Bretonneau used mercurials freely, but his
mortality was great, and contributed to induce a general distrust of the
treatment. West, however (Ed. 1859), still considered calomel useful
for " counteracting the tendency to formation of false membrane and
preventing lung-inflammation." I have been myself much disappointed
with the action of calomel in these respects, but the red iodide and the
cyanide of mercury, in doses of -fa to -fa gr. every two to four hours,
have exerted a more favorable influence in some severe cases. It is very
important to watch their action carefully, and not to induce salivation,
for according to general experience " this promotes rather than checks
the spread of exudation " (Mackenzie), and certainly, as a general rule,
other remedies of a tonic or antiseptic character are often to be preferred
to mercurials.

Tonsillitis, etc. In ordinary tonsillitis, and even in suppuration about
the fauces, I have seen much advantage from small doses of hydrarg. c.
creta. In early stages of quinsy, in ulcerated sore throat, and even in
the "putrid" form (cynanche maligna), gr. given every two to four
hours has induced rapid improvement. It does not exclude the use of
aconite or belladonna if indicated by high temperature or much pain.
In parotitis (" mumps "), also in glossitis, " cancrum oris," and cracks
and ulcerations about the mouth and lips, the same treatment is very
effective. For relaxed congested conditions of the faucial membrane the
value of dilute solution of mercurial nitrate has been already indicated.

Scarlatina. The small doses of hydrarg. c. creta just mentioned I
have found equally useful in the severe specific sore throat of scarlatina,
especially when the cervical glands and adjacent cellular tissue are in-
flamed and swollen, and when there is ulceration or even a tendency to
gangrene.

Morbilli. Half-grain or quarter-grain doses of gray powder given



MERCURY. 217

every four hours will also control the catarrhal symptoms of measles:
when the conjunctivas and mucous lining of the nose, mouth, and throat
are inflamed, and even when ulceration is present, they render excellent
service.

Variola. When the eruption is passing into the pustular stage, and
when secondary fever is setting in, I can recommend -gr. doses of hy-
drarg. c. creta, every three to four hours, for a few days. Unless the
gums show signs of tenderness, this treatment tends to check and limit
suppuration, and consequently to lessen in some degree the chances of
pitting. The local use of mercurial ointment has been already mentioned
(v. p. 207).

Enteric Fever. We need not here refer to the older method of treat-
ing this fever by repeated purgative doses of calomel (v. Stille), a method
not now advocated; but several eminent physicians abroad Traube,
Wunderlich, Liebermeister, and others have recently recommended a
" specific" treatment for the first nine days of this fever by calomel, giv-
ing 10 gr. in a single dose the first day, and 8 gr. (in divided doses) daily
for three or four days afterward. They claim for these doses an antipy-
retic effect, and a power of lessening both the duration and the mortality
of the disease (Medical Times, ii., 1876). I have not had experience of
this treatment, nor, although foreign statistics show good results, has it
made way in this country. An early moderate purgative dose is, how-
ever, often advisable, and Black has written to recommend one or two 5-
gr. doses of calomel during the first week, as "antiseptic" (Lancet, i.,
1875). Corrosive sublimate in minute quantities has also proved valua-
ble in typhoid diarrhoea (British Medical Journal, i., 1874), and this is
in accord with my experience, but with these exceptions mercury is not
indicated in the treatment of this fever.

Puerperal Fever. Traube has also revived mercurial treatment in
some cases of this disease not for the general blood-poisoning but at
the commencement, when phlegmonous inflammation is spreading from
the uterus, and involving other parts, e.g., the peritoneum or pleura. He
considers that a rapid and energetic mercurializing by calomel and inunc-
tion gives the best results, and states that such cases bear large doses,
and that improvement generally coincides with the first signs of saliva-
tion. Spiegelberg especially observed the good influence of corrosive
sublimate in similar conditions he gave -^ gr. at a time (Nothnagel).
Concerning this treatment, I can only say that I have not had occasion
to adopt it, aconite, opium, quinine, etc., seeming to be much more de-
sirable remedies.

Erysipelas. In many cases of phlegmonous erysipelas, especially
when occurring in strumous subjects, I have found the internal adminis-
tration of corrosive sublimate distinctly useful.

Syphilis. In 1497 Gilinus first employed mercury in the treatment



218 MATERIA J1EDICA AND THERAPEUTICS.

of the then epidemic of syphilis, borrowing his practice from that of the
Arabians in skin diseases, and using only external applications, by fric-
tion, bath, or fumigation. Several serious accidents that occurred from
the remedy as used by empirics contributed to discredit it, and in 1517
it was almost entirely superseded by guaiacum. Not long afterward,
however, the internal administration of corrosive sublimate, red precipi-
tate, and calomel became general, and by the time of Boerhaave was car-
ried to such excess that mercurial treatment was not considered thorough
and satisfactory till it secured the ejection of three or four pounds of
saliva in twenty-four hours. But some protest against such abuse was
not wanting, and between mercurialists and anti-mercurialists sprung up
a controversy which has lasted to our own time. In the early part of
this century a reaction of opinion against the extravagant use of the drug
in syphilis became general thanks mainly to Rose and Guthrie, Thom-
son and Abernethy and it was proved that syphilis sometimes tended
to spontaneous cure, and yielded to non-mercurial treatment. Later on,
an important distinction was made out between the soft or non-infective,
and the hard infective sore, and professional opinion pronounced strongly
in favor of mercury for the latter, while allowing it unnecessary in the
former, and in gonorrhoea. This was clearly evidenced in the report of
the Admiralty Commissioners on the subject, which records the opinions
of forty eminent practitioners (1864). Among others, Sir James Paget
called mercury "a specific if the patient could take it well; in favorable
cases it would prevent secondary symptoms, and at least it would shorten
their duration." Mr. Hutchinson speaks of it as a " true vital antidote,
and if given early, as really stopping the development of symptoms, and
absolutely curing the disease." While agreeing in the main with this
conclusion, I do not discard wholly the use of mercury in soft chancre,
for I find that small doses cause the sore to heal more quickly than any
other medicine.

Constitutional syphilis is commonly divided into three stages, fairly
well distinguished as primary, secondary, and tertiary, and the best pe-
riod for giving the remedy has been much discussed. Some have main-
tained that its early exhibition only defers the appearance of secondaries,
and it is better for these to appear and then to give mercury till they dis-
appear; but the best authorities favor early commencement. Ricord gave
mercury generally the iodide so soon as the hard chancre was distinctly
diagnosed, and insisting on a year's continuance of treatment, was satis-
fied that he prevented secondary symptoms. Barallier supported the
same conclusion after much experience among sailors. The majority of
British surgeons follow this practice at present, and it seems to me the
right one>

On the other hand, most are agreed that in tertiary stages of syphilis,
mercury is not a desirable remedy, and Dr. Wilks finds a reason for this



MERCURY. 219

in the different processes which occur at different periods of the malady.
In the primary and secondary periods, plastic lymph is being effused, but
in later stages degeneration is going on; mercury causes absorption of
the effused products, but its further action can only assist degeneration,
induce cachexia, and be thus injurious (Guy's Reports, vol. ix.). As
clinical evidence of this, if any were needed, reference might be made to
the cases recorded by Mr. Hutchinson, where phagedasnic ulceration in
delicate subjects distinctly increased under the influence of mercury
(London Hospital Reports, vol. ii.). Also, if any syphilitic sore be much
inflamed, or if aggravated dyspepsia, amemia, phthisis, or albuminuria is
present, special treatment for these conditions must be instituted inde-
pendently of mercury. Pregnancy has been, by some, considered a bar
to due mercurial treatment, but, in my opinion, the danger of miscarriage
in the mother, and of injury to the infant, are greater from syphilis than
from mercury.

In any case, a moderate use of the drug must be the rule. It is true
that Trousseau and Pidoux blame a relaxation of the old methods for
what they consider the present gravity of the disorder; but the large
majority of the best authorities, including Ricord, Sigmund, and Hutch-
inson, deprecate full mercurialization, and find the best effects from small
doses continued for a long time. Sigmund states that of nearly 9,000
patients treated in the Vienna Hospital, 8,500 showed no sign of saliva-
tion, but were cured as permanently as those salivated (Medico- Chirur-
gical Review, July, 1858). Slight tenderness of the gums may be safely
and properly produced as evidence of systemic influence, and a method,
sometimes successful, is to give fractional doses (-^ gr.) of calomel every
hour; given in this manner, 3 gr. may suffice for the purpose (Law, Dub-
lin). In all forms of tertiary syphilis, rupia, and deep ulcerations, espe-
cially of mucous membranes, tongue, and fauces, gummata, visceral
syphilis, and most syphilitic nerve-affections, the great remedy is not mer-
cury, but iodide of potassium, though in hereditary syphilis mercury is
still to be preferred.

In syphilitic iritis and retinitis, the early and sufficient use of mer-
cury is perhaps more clearly indicated than in any other .inflammation,
and they are the only conditions in which Ricord held even salivation
justified. Watson has graphically described how effused lymph in the
anterior chamber may be seen to " melt away," under the influence of
the drug; but unfortunately, this is evident only in syphilitic cases. I
often combine with its internal use, collyria of corrosive sublimate, 1 to
2 gr. in 6 oz. of water with opium, or an ointment of ammonio-chloride
with belladonna for frictions round the orbit, with good success; but the
same treatment cannot be depended upon in rheumatic or traumatic
cases.

In syphilitic laryngitis also, mercury must be promptly and freely



220 MATERIA MEDIC A AND THERAPEUTICS.

used, for in acute cases life is rapidly endangered by the disease. Syph-
ilitic infants, as a rule, develop only a subacute form of this disease,
which may be treated less actively by moderate frictions with very satis-
factory result. (For catarrhal laryngitis, mercury is not indicated.)

Scrofula. Not only in syphilitic, but also in scrofulous diseases, small
doses of mercury are useful. I know that this is not so commonly rec-
ognized, but or 1-gr. doses of hydrarg. c. creta twice daily will often be
found of great advantage in purulent discharges from the eye, ear, etc., as
also in chronic glandular swellings.

Hepatitis. Annesley recommended in this inflammation, large doses of
calomel to the production of salivation, which he looked upon as " deriv-
ative," and no doubt at one time, as Maclean observes, " faith in calomel
may be said to have attained in India to the dignity of a dogma." He,
himself, strongly objects to any systematic use of mercury, and suggests
that if it has gained credit for preventing suppuration, this has been in
cases which were really of "peri-hepatitis" and not likely to end in ab-
scess; in a large experience he has never seen it arrest suppuration, and
"disbelieves in any such power" ("Reynolds' System," vol. iii.). More-
head and Waring agree in this opinion, and Massy reports serious impair-
ment of health after its free exhibition. These authors may be taken as
representing the present state of general opinion, but I think they have
been too strongly prejudiced against the remedy by its excessive use, or
abuse, and that small continued doses, stopping short of any full physio-
logical effect, may still be found of advantage in commencing hepatitis;
occasionally, larger (purgative) doses act well. In chronic forms of liver
inflammation, when the viscus is large and tender, mercury is also suit-
able, though if marked cachexia be present, or suppuration be fully de-
veloped, the drug is better avoided.

Cirrhosis. Monneret has strongly recommended moderate doses of
blue pill in cirrhosis with dropsy (Archives Gen., September, 1851), stat-
ing that after the numerous stools and copious sweatings induced, effusions
are often absorbed, without any ill-effects from salivation. Barallier cor-
roborated this experience, and further reported a case, not far advanced,
which was cured by this treatment (Dictionnaire). I have certainly had
the best effects from mercury in cirrhotic dropsy, but have generally used
purgative doses of blue pill, or calomel, followed by salines, and in the
intervals of purgation have given nux vomica and other tonics. Under
such treatment large abdominal effusions have passed away six times in
one case, at different intervals, so that the patient was restored to com-
parative health for some time, and this without any mercurial ill-effects.
The diagnosis was verified post-mortem, but I cannot say that I have seen
the malady permanently cured by this or any other treatment.

Hepatic Congestion Constipation. In torpor, or subacute conges-
tion of the liver, marked by coated tongue, yellowish countenance, head-



MERCURY. 221

ache, nausea, depression, light-colored stools, etc., a moderate mercurial
purge, especially with a saline, will commonly relieve more quickly than
anv other medication (unless it be sometimes podophyllin), and no amount
of experiment on animals can alter this clinical fact. The great expe-
rience and authority of Murchison quite corroborate this (Lancet, 1874),
and Dr. Duckworth has lately drawn renewed attention to the good re-
sults of calomel in acute gastric catarrh and " biliousness " (Practitioner,
July, 1876). In chronic cases of this kind it is, however, advisable not
to resort frequently to this remedy, but to depend rather upon diet,
hygiene, and saline or vegetable aperients, though small doses ^ to $
gr. of corrosive sublimate at bedtime have a good effect. The use of
metallic mercury as a purgative might be thought obsolete, but an in-
stance of it has been recently recorded, where obstinate obstruction and
vomiting were present: 1 oz. of quicksilver was given in two doses at
half an hour's interval; it soon acted, and recovery followed (Lancet, i.,
1874, p. 54). I have myself used it in two cases lately: one was that of
a boy, aged eight, who had had obstruction for five days, and although
under active and competent treatment, continued to get worse, with
vomiting, pain and accumulation over ilio-csecal valve, distension, etc.
Surgical interference was desired by the parents, but in consultation it
was agreed to try mercury first, and 1 oz. was given in the manner just
described. It was readily taken, and some of it soon passed, but with-
out producing a motion; the symptoms improved, and on the following
morning we gave castor-oil, which acted well, and the child soon recovered.
The whole of the quicksilver passed was collected and weighed and found
to amount exactly to the ounce taken. In a second case, a girl, aged
between five and six, the obstruction had lasted several days, and the
vomiting and other symptoms were persistent in spite of croton oil, etc.
I recommended, at first, treatment by opium, which was steadily con-
tinued for three days, but without benefit; castor-oil was then given but
was rejected; we then gave 2 dr. of quicksilver, in five minutes afterward
another 2 dr., and in half an hour a third and similar dose. It made its
appearance from the rectum in about two hours, bringing wind but not
much fecal matter; we followed up the mineral with castor-oil, which
was retained and acted, and the child gradually got well.

Vomiting. In some forms of obstinate vomiting, dependent upon
disordered stomach, with hepatic congestion, 3 to 5 gr. of calomel in pill
or powder, have a most beneficial effect. The dose should be followed
after a few hours by a saline purge.

Diarrhoea (Infantile). When the motions are green, curdled, watery,
and offensive, small doses (J gr.) of gray powder act very well, especially
when combined with bismuth, and the same powders are useful when
curdled milk is frequently rejected from the stomach. When there is a
simple diarrhoea, with whitish stools, Dr. Stephenson thinks that rhubarb



222 MATERIA MEDICA AND THEEAPEUTICS.

and soda should replace the mercurial, for fear the latter should depress
the strength (Edinburgh Medical Journal, 1871), and certainly, if it be
continued unwisely, it may do so by irritating the mucou~s membrane,
etc., but I have never seen ill-effects from the minute doses above recom-
mended. For infantile watery diarrhoea -j-J-^j- to -fa gr. of corrosive sub-
limate after each motion acts well (with due care). I think this is now a
common experience; I have acted upon it for twenty-five years. In the
acute diarrhoea and colic of adults, one of the best methods of treatment
is the use of a pill of calomel (3 gr.) with opium (1 gr. or gr.), followed,
after three or four hours, by castor-oil or other laxatives.

Dysentery. In acute dysentery, with violent pain, severe prostration
and frequent muco-sanguineous stools, small doses of corrosive sublimate,
given at short intervals, commonly relieve in a few hours, and almost
in a " specific " manner certainly better than any other remedy I have
known. Sublimate is equally useful in the " white dysentery " of Ceylon
and India. I have seen the best results from it when opium, lead, and
other astringents had proved useless. I thus agree with Wood, who as-
serts that in this malady " no remedial influence is more effective than
that of mercury," rather than with Maclean, who deprecates its use in all
forms and stages. I can only suppose that the injurious effects traced
by him and by others to calomel, etc., resulted from doses that were too
large.

Cholera. Dr. Maclean equally objects to any preparation of mercury
in cholera, as " useless in collapse and dangerous when reviving " (Lancet,
1866), but although I am not myself an advocate for the calomel treat-
ment, the results obtained by Dr. Ayre, of Hull, deserve attention. He
gave to -fa gr. calomel every ten minutes or every four hours, according
to circumstances; it rarely salivated, but produced apparently good re-
sults in a majority of cases. Bloxam and some other observers have fol-
lowed the same plan with advantage, and Niemeyer speaks well of calomel
treatment. What is desired is to stimulate by this means a secretion of
bile and to promote elimination, for we know that the reappearance of



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 27 of 40)