A PRACTICAL TREATISE ON THE GONORRHOEA, RECOMMENDING THE USE OF INJECTION As the most speedy and efficacious METHOD of CURE WITH A brief ACCOUNT of the REMEDIES which have been used in the LUES VENEREA, From its first Appearance in EUROPE; AND A CRITICAL ENQUIRY INTO The present MODES of administering MERCURY.
By PETER CLARE, SURGEON.
Non mihi, sed rationi.
A NEW EDITION WITH ADDITIONS.
LONDON: Printed for T. CADELL, in the STRAND. MDCCLXXXIII.
PREFACE.
THERE are two very different methods of curing the Gonorrhoea, the one wholly by internal medicines, the other principally by injection. The former is generally a very uncertain and disagreeable process, the latter is both expeditious and safe, but dreaded by many persons on account of a false idea which has long prevailed. This ill founded notion it is my business at present to confute by several arguments supported by quotations from Authors of distinguished credit.
Mr.
Pott
recommends the advice given by Lord
Bacon
to a student, "to consider one disease at a time, and to become thoroughly acquainted with that, before he undertakes another." He further observes, "that the only means by which true and useful knowledge is to be obtained in every part of surgery, are a competent knowledge of the anatomical structure of the human frame, a close attention to the symptoms of diseases in the living, and a minute examination of the appearances in the dead: these are the great fountains of all medical knowledge." Mr.
Pott
has here pointed out, in a very judicious manner, the path which every chirurgical practitioner and writer should pursue, who undertakes to explain the true nature, seat, and cure of any bodily disorder.
Chancery-Lane,
January 1, 1783.
TABLE OF CONTENTS.
TREATISE on the Gonorrhoea. Page 1
On the Cure by internal Medicines. Page 10
Particular Observations on Nitre. Page 12
Injections strongly recommended. Page 17
Objections to them answered. Page 18
On the Difference between Pus and Muens. Page 20
Brief Account of the Remedies used for the Cure of the Lues. Page 25
A Critical Enquiry into the different Methods of administering Mercury. Page 29
Objections to Mercurial Pills, &c. Page 37
Objections to Mercurial Ointment. Page 41
A Recapitulation of the Argument, with additional Observations. Page 45
A TREATISE ON THE GONORRHOEA.
THE part principally affected by the Gonorrhoea is the penis, which consists of three parts; two of which are called corpora cavernosa, and lie on each side, and a third, which is situated underneath, named corpus spongiosum urethrae, consisting of the bulb and membranous part, continued on to the bladder, and terminating at the other extremity in the corona, or glans penis. The urethra has three glands, which were discovered by
Cowper,
and called mucous glands, from the tenacity of the liquor which they separate. There are also two, (or rather one,) about the size of a nutmeg, they lie at the neck of the bladder, between the vesiculae seminales and penis, under the ossa pubis, almost within the pelvis of the abdomen; they separate a limpid glutinous humour, which is carried into the urethra by several ducts, which enter near those of the prostatae The two first of
Cowper
's glands are about the bigness of a French bean, of a depressed oval figure, and a yellowish colour like the prostatae, being on each side the bulb of the urethra, a little above it. Their excretory ducts arise from the internal surface next the inner membrane of the urethra, into which they open a little lower by two distinct orifices, just below the curvature of the ossa pubis in perinaeo, where they discharge a transparent viscous liquor. The third mucous gland is a small conglobate yellowish gland, like the former, but somewhat less, situated above the angle of the flexure of the urethra, under the ossa pubis, in the perinaeum, near the anus: it has two excretory ducts, which enter the urethra obliquely, a quarter of an inch below the two former, and discharges a liquor like them both in colour and consistence.
The seat of the Gonorrhoea in women is the vagina, which is affected with a discharge charge like that of the urethra in men. It lies between the bladder and intestinum rectum, and has rugae, under which are small glands, whose excretory ducts are called lacunae. These glands separate a mucilaginous slimy liquor to lubricate the vagina, and are the seat of the Gonorrhoea in this sex, as the glands in the urethra are in the male. The meatus urinarius being a very short passage, the heat and scalding is consequently much less than in the men.
"A Gonorrhoea from the urethra in a man, begins with an uneasiness about the parts of generation, together with an appearance of a little whitish matter, about the orifice of the urethra, a little swelling and sometimes redness there, and a slight pungency upon the evacuation of urine. The whitish matter soon increases in quantity, the inflammation about the end of the urethra becomes more evident, and for the most part there is now a tension and hardness through the whole of it, a swelling of the lacunae, and a sensation of stricture in the penis, particularly on erection. The matter still increases, flows out, and grows thinner, loses all its adhesiveness, and is of a yellow, or greenish colour. There is now always a redness about the end of the canal; often a pain from the distention of the urethra, during the evacuation of urine, and a much severer towards the orifice, from its stimulus, with an increase of the redness just after it is evacuated. The inflammation prevents the extension of the urethra in erection, so that the penis is at that time curved downwards with great pain, which is increased if it be raised towards the belly, and the stimulus occasions it often to be erected, especially when warm in bed
Dr.
Fordyce
's Elements of Physic.
."
I believe it would generally be esteemed good practice on this occasion to give nitre in considerable quantity, a purging electuary, pill, or salts, and to take blood freely from the patient; also to direct large quantities of diluting liquors, and further to recommend a strict regimen and abstinence from particular meats, vegetables, and strong liquors. The question is, are such medicines and restriction necessary? In my humble opinion they are not, and they appear, upon the whole, to do more harm than good, as I shall endeavour to demonstrate from the experience of those who are well qualified to give an opinion in a matter of this kind, and also from my own observation and practice.
Dr.
Cullen
remarks, "that purgatives not only inflame the rectum, but also extend their irritation to the urethra." May not chordee and priapism then often be attributed to this cause?
Dr.
Fordyce
recommends "increasing the secretion a little, by such gentle purgatives as procure only two or three evacuations a day."—But who can ensure his patient two or three stools only in a day? The intestines being once put into motion, will not accommodate themselves exactly to our wish or convenience. Happily for the patient, it is certain that even gentle purging may be dispensed with on these occasions.
He adds, "that severe purging often augments the inflammatory symptoms, brings on strangury and exulcerations, gives occasion to inflammation of the testicles, and other neighbouring parts, or it stops the running before the infection is washed off, and the Gonorrhoea either returns in a few days, or exulcerations take place."
The Doctor further observes, "that long continued purging is apt to weaken the stomach and intestines, to hurt the digestion, to produce obstinate gleets, and leave hypochondriacal symptoms, particularly in irritable or melancholic habits."
Many more authorities might be adduced in proof of the bad effects of a course of purgatives in these cases, which are generally of considerable duration, when treated in this manner. Neither are antiphlogistic remedies to be depended upon, as they sometimes produce the very contrary effect to what was expected from them: amongst the first of these is nitre, in inflammatory disorders. Dr.
Lewis,
a late writer of no small credit, reckons, that nitre often gives relief in stranguries, and heat of urine, proceeding either from a simple or a venereal taint; and indeed the greatest part of practitioners have always given it, and still continue to give it in the venereal
ardor urinae.
"This practice, however, says Dr.
Hope
in his lectures on the Materia medica, I am apt to believe has taken its rise from the name of ardor having always been given to the pain in evacuating the urine, during the time of a venereal inflammation of the urethra, and the name and virtues of a cooler, having always been attributed to this salt. But it is certain that the urine passed during the time of a venereal inflammation is no warmer than at other times, and therefore to prescribe a cooler to allay the heat of it, is absurd: and I am persuaded, that on a free and candid examination of this matter, it will be found, that nitre has not the smallest power of alleviating the pain which is then felt; for I have given it in all the different stages of this disease, in small and in large doses; but from the sole use of it in a great number of trials, have never been able to observe that it afforded the least relief. Nor, when we consider the cause of that pain, and the effects of nitre, have we any reason to expect it; for the pain certainly proceeds from the acrid salts in the urine, stimulating the inflamed or excoriated urethra; and a solution of nitre applied to any excoriated part always gives considerable pain. Experiments assure us, that on taking nitre into the stomach, the urine becomes impregnated with it. The larger therefore the doses are, the stronger will this impregnation be, and the greater stimulus added to the urine; so that we may sensibly conclude, that this salt will rather augment than diminish the pain in evacuating it. The Doctor further remarks, that there are many weak and delicate stomachs which cannot bear the cold it produces, and others in whom it always creates sickness and nausea."
Besides the disagreeable circumstance of taking great quantities of nauseous medicines, we find there is the greatest uncertainty as to their real effects on the diseases they are intended to remove. A powder or medicine of any kind, applied to blood in a bason, may visibly affect that fluid, and render it thin or thick; yet being taken into the stomach, and possibly from thence into the circulation, it may have a very different effect on the circulating fluids, or perhaps none, having undergone a material alteration in its course.
A late celebrated Lecturer on the Materia Medica, discoursing with his pupils on the powerful operations of mucilaginous medicines in the alleviation of the pain arising from the stone in the bladder, remarked that such medicines were extremely useful where the stone was of the mulberry kind, and apt to vellicate the coats of the bladder. He told them the ropy mucilage would envelope the stone, and make a uniformly smooth surface, entirely depriving it of its asperities, and consequently of its power of hurting the bladder.
It is difficult for one conversant with the mechanism of the human body, and the operation of medicine, to conceive, that a mucilage given by the mouth will arrive at the bladder in that state. We are certain that particular remedies will stimulate particular parts: balsam of capivi, for instance, being absorbed, is known to affect the kidnies and bladder, by the strong odour it imparts to the urine; but we do not find this, or any other medicine, except quicksilver, will pass off in the same form in which it is administered by the mouth. This balsam is very much esteemed for its great virtues, particularly in certain stages of the Gonorrhoea, but it is so very disagreeable, on account of its oily and bitter quality, as well as its smell, that some patients are soon disgusted with it, and others will not be prevailed upon to take it at all; we cannot therefore think it strange, that many gentlemen should often prefer injections to all other means, which do not appear to produce effects in any degree equal to the trouble which attends them. It must be acknowledged that patients often suffer more from the remedy than the disorder; they are often more emaciated, weak, and pallid in their countenance, (circumstances which frequently lead to disagreeable discoveries,) from the operations of purgatives in the space of one week, than they would have been in a month, if there had been no attempt made to check the progress of this disorder.
There are many people who have not leisure to pursue the several directions and prescriptions given by practitioners; and if they could find time, they would have but little inclination to undergo so much fatigue and trouble. Such tedious processes are very ill contrived for the multitude, who must be,
and are daily cured by means much more easy, expeditious, and quite as effectual;
and if one class of men are cured in this manner, why should not all enjoy the same benefit?
I have asserted, that a regimen, or particular diet, is not necessary in the cure of the Gonorrhoea, when treated in the manner here recommended. Some have asked, if the disorder is not inflammatory, and if living low is not indispensibly necessary in every complaint of this kind? It may be said in reply, that this is a local inflammation, which yields at once to a cooling detergent liquid applied to the part; whilst internal medicines are commonly slow and uncertain in removing it.—When mercury does not pass into the stomach, there is no occasion to enjoin restrictions with respect to diet, since no disagreement can then happen; patients may live in the same manner as at other times, only avoiding excess.
Dr.
Hugh Smith,
who is an advocate for vitriolic injections, asserts, "That a Gonorrhoea, if taken in the beginning, may generally be cured in a fortnight, without any injuty to the constitution, or any ill effects whatsoever
Dr.
Smith
's Formulae Medicamentorum.
."
I have met with the greatest success in the cure of this complaint from the same sort of injections, and find they answer much better than mercurial ones, which deposit a considerable sediment, and being conveyed into the urethra, cause irritation and pain in that tender passage.
The injection should be applied cold, rather than warm, (as cold braces and warmth relaxes,) which I find often completes the cure in much less than a fortnight, the time mentioned by the Doctor.
If the injection causes any more than a slight sensation of smart or pain in the passage, it is evidently too much impregnated with vitriol, and the solution must be made weaker, as the irritation of the liquor would increase the symptoms instead of diminishing them.
The great objection to this sort of practice is raised on the supposition that
Injections
are apt to produce
stricture
in the urinary passage, This idea, I apprehend, is not well founded; having enquired of many different people who have been troubled with
strictures,
if they had used injections for the cure, and was generally answered in the negative.—I am much inclined to think with Doctor
Fordyce,
"That when a
gonorrhoea
continues long, it sometimes produces a
stricture
in the part." Inflammation is naturally disposed to produce contraction and
stricture
in the different sacculi and passages of the body, as well as in the
urethra:
therefore we may conclude, that evils are often attributed to
Injections,
which in fact owe their origin to other causes
If the long duration of this distemper produces strictures and obstructions, then what removes the disorder quickly, must undoubtedly prevent the above evils, instead of causing them.
. The same gentleman justly observes, that omitting the
injection
once or twice will often make it fail of curing, when it would have otherwise produced that effect
If the Injection should not produce the desired effect, it will be right to enquire if the urine passes freely, and whether it divides into two streams, or more; or whether it comes out twisted, like a cork-screw. In these cases, it is not likely the Injection should effect its purpose, being unable to pass: recourse must therefore be had to the
Bougie
to restore the passage to its natural state.
. He likewise remarks, that patients treated in this manner, are less liable to inflammation of the testicles, or of the glands in the groin (on to
chancres
) or
strictures.
These observations are certainly founded on fact. It is the general opinion, that small doses of mercury ought to accompany the
Injection.
See
Fordyce, Saunders, Smith,
and others.—Conformably to this idea, I give a grain of mercurial powder, and apply it to the cuticular surfaces of the lips, or the tongue, and at the same time make use of the
vitriolic,
in preference to every other
Injection.
Though I have made repeated trials of several, I know of no other which would remove the disorder in twice the time which this does; but there are some that would not succeed at all, and rather aggravate the symptoms.
It is now proved by a repetition of ingenious experiments, and generally admitted, that the discharge in a
Gonorrhoea
proceeding from the
wethra,
is not
pus,
but
mucus. Pus
is the matter which proceeds from wounds and ulcers, but
mucus
comes from surfaces not ulcerated, though sometimes inflamed. Dr.
Hunter
says, he has often dissected the
urethra
of persons who have died, having the
Gonorrhoea
at that time, and he adds, that he never discovered any ulcer in the passage.
Mucus
is, in itself, an innocent, mild fluid, but capable of acquiring virulence and acrimony from contagious infection.
The Gonorrhoea is an increased and virulent discharge from the
mucous
glands
Described in Pages 1 and 2.
of the urinary passage. Mucus, when untainted, is transparent like the white of an egg, appears as a drop sometimes at the orifice of the urethra next the glands, is of a mucilaginous viscidity, and its use is to sheathe and defend the passage from the irritating salts conveyed in the urine. It resembles the fluid in the eye, which is secreted in small quantity, but when the lachrymal gland is stimulated by grief, dust, or other offending substance, the discharge becomes copious and sometimes acrid.
Darwin
observes, in his experiments on pus and mucus, "That whenever the secretion of any fluid is increased, there is at the same time an increased heat in the part." The same gentleman observes, that "the catarrhal humour from the nostrils of some who ride in frosty weather, and the tears which run down the cheeks of those who have an obstruction of the puncta lachrymalia, are easily distinguished from others, by their abounding in ammoniacal or muriatic salts, whence they inflame the circumjacent skin: thus in the catarrh, the upper lip becomes red and swelled from the acrimony of the mucus, and patients complain of the saltness of its taste. The eyes and cheeks are red with the corrosive tears, and the ichor of some herpetic eruptions erodes far and wide the contiguous parts, and is pungently salt to the taste, as some patients have informed him."
When the mucous membrane of the nose is stimulated by a violent cold, or other cause, we often see an extraordinary quantity of discharge from that organ; yet no one suspects the existence of any ulcers there, and I have often observed, that the discoloured mucus of that part bears so strong a resemblance to the virulent discharge in the gonorrhoea, that it would frequently perplex persons conversant in these matters to distinguish two handkerchiefs, the one from the other, when stained with the respective mucus. Either of these fluids having acquired acrimony will inflame, and sometimes slightly excoriate irritable nervous membranes. These excoriations generally heal of themselves, and when they do not, no one hesitates to apply repellent and healing medicines to the part, without even the smallest suspicion of any bad consequence. With ulcers the case is very different, there being the greatest reason to apprehend danger from the absorption of matter into the circulation. Writers of good credit assert, that a drop of acrid pus, absorbed into the blood, affects all the fluids, stimulates the vessels, and is capable of producing violent disorders, such as putrid fevers, &c. Impressed with such a belief, no thinking man, in this or any age, would adopt a practice at once so irrational and dangerous: but as the discharge is merely mucus, and has no concern with the system or animal oeconomy, it may be safely washed away, like any other
sordes,
or filth from the surfaces of the body, by injections, which are not only far more expeditious in producing their effects, but also appear, on a due comparison of the merits of each, to possess another advantage, that of being a more cleanly, safe, and agreeable method of cure, than any other whatsoever. I have only to add in this place, that I am confirmed more and more in the use of injections, which entirely answer the above description and commendation.
A BRIEF ACCOUNT OF THE REMEDIES in USE for the CURE OF THE LUES VENEREA, FROM ITS First Appearance in EUROPE.
THE cure of this disorder, which has now prevailed all over
Europe
near three centuries, has not been so much improved by the profession as might have been expected during so long a period. It raged for several years uncontrouled, before an effectual remedy for it was discovered. After the antidote for this poison was found to exist in mercury, yet still so very unfortunate was the applicat on of it, that many lives were lost by salivations, shocking to relate, in consequence of the want of sufficient knowledge of the nature and qualities of this mineral, in the practitioners of those times.
"The first attempts of the cure of venereal maladies, by this remedy, were learned from the
Arabians,
who having recommended mercurial ointments in the
Leprosy
or scabies, gave a handle to the
Italian
physicians, to try their efficacy in removing the foulness of the skin from a new and terrible contagion: neither were they sparing of their liniments, which they continued to rub in for twelve, fifteen, nay, sometimes for above thirty days together
Mead
on Poisons.
," a very dangerous practice, which prevails too much even in the present age. Sarsaparilla, sassafras, guaicum, have all at different periods been in more or less estimation for their antivenereal virtues; but mercury is the only antidote for this poison, on which any age has reposed an entire confidence.
In 1685, Dr.
Sydenham
wrote on this amongst other subjects. His account shews, that although the use of the remedy was better understood, yet the cure of the disorder was but little improved.
In 1731, Dr.
Turner,
a member of the College of Physicians in
London,
who had made the Venereal Disease his particular study, thought proper to communicate his observations and practice to the world. His drastic purges, and mercurial prescriptions, were such as might destroy the most robust constitution; what then must have become of those of a weak and delicate frame?
Dr.
Boerhaave
has advanced a system of his own, apparently less detrimental than former ones, and which has been very much adopted of late years. The Doctor's theory of the disease is, that it is seated in the fat; therefore evacuations which destroyed it, must, in his opinion, contribute greatly to the cure of this disorder; for which reason the Doctor recommended the most powerful sudorifics and purgatives, the former of which though hurtful, are less prejudicial to the constitution than the latter.
Dr.
Astruc,
a celebrated writer, has given a very sensible and accurate description of the
Lues Venerea
in all its stages, with directions for its cure; but the remedies are as violent as those recommended by preceding writers, and ought therefore to be exploded.
Baron
Van Swieten
recommends
The Corrosive Sublimate
to be given internally. It had hitherto only been used externally to
fungus
in wounds, on account of the violence of its nature. Even when administered in rum or brandy, to correct it, the stomach can seldom retain it, for which reason it has grown into disrepute, although it has a most astonishing and rapid effect in removing venereal symptoms.
Mr. Professor
Plenk
advises the giving
Quicksilver with gum arabic,
to prevent it from exciting a salivation. This is the least prejudicial of all the modes of administering mercury internally.
Fumigation,
which is lately revived, I have often seen applied to sores with hardly any perceptible advantage, and sometimes it gave great pain, and did a manifest injury.
Two circumstances have conduced greatly to the better treatment of this complaint, within these twenty or thirty years; I mean, the extraordinary improvements in anatomy and chymistry: by the former we have acquired a better knowledge of the seat of this disorder, and by the latter, of the medicines employed to effect it's cure.
A CRITICAL ENQUIRY INTO THE OPERATION OF MERCURY, AND THE DIFFERENT Modes of administering it considered.
DIFFERENCE of opinion prevails with regard to the mode of administering mercurial preparations; the advocates for each, giving their reasons for that which they adopt in preference to any other. The
alterative
method is much in esteem and practice, and with some deviation and caution may be rendered very beneficial.
This appellation of
alterant or alterative is given to all such medicines as correct the bad qualities of the blood, and other animal fluids, without occasioning any sensible evacuation.
According to Dr.
Woodward,
all that is commonly alledged concerning the change of principles or ferments of diseases by alterant remedies, is merely chimerical and imaginary; he remarks, that there is no change made to the advantage of the human body without a successive renovation and discharge of what is hurtful, and a supply of its place by something innocent.
The Doctor gives the preference to evacuants, as being the only medicines capable of freeing the machine from whatever incommodes it. Some take a contrary course, and ascribe even the salutary effects of evacuants to their alterative nature, which has been alledged of mercury in the cure of the venereal disease. Among alterant medicines there are several which change the scene of the symptoms, and others which suspend the action of the morbific matter for a time; but these remedies which hold the morbific principles captive pro tempo
e, are only palliatives, and even on some accounts dangerous, since they may as well captivate other principles necessary to lise.
Dr.
Fordyce
says, "Whatever preparation we employ, we should give it in such a manner, and in such a dose as to produce hardness, fullness, and moderate frequency of the pulse, with as little sensible evacuation as possible; for that the mercury cures sooner and with greater certainty, when the strength is but little, than when it is much reduced by it."
Mr.
Plenck
is of opinion, "that mercury, together with the venereal virus, may be more conveniently and more easily evacuated by the ordinary excretions of sweat, stool, and urine."
It seems to me much more safe to permit the gradual evacuation of mercury (after it has circulated some time, and subdued the virus) than to confine it within the body by opiates, or other means, so as to occasion hardness, fullness, and acceleration of the pulse. The saturation or surcharge of the system with mercury is very hazardous, as it sometimes terminates in a fatal diarrhaea. Surely it is most prudent to permit a little of the mercury to depart, and throw into the circulation such a proportion only, as may be altogether safe and yet sufficient to keep up a gentle mercurial stimulus in the habit.
Mercury and wine operate somewhat alike upon the body. With a certain quantity of wine, hardness, fullness, and acceleration of the pulse will supervene, till at length in common an evacuation takes place; when it does not, and the wine is retained there, (like mercury exhibited as an alterative), it excites feverish heat, and does the constitution much more injury than when it passes off gradually by any of the ordinary evacuations.
Dr.
Fordyce
observes, "it is never necessary to salivate a patient, unless he be so irritable, that the smallest dose of mercury immediately affects his mouth, or unless the disease be proceeding so fast that it would be hazardous to wait till it was checked by the remedy given in such a manner as to avoid salivation; or excepting when we cannot trust to his using it regularly. On the contrary, salivation renders the effects of the medicine uncertain." The same author says, "If, notwithstanding these precautions, a salivation should come on, we know of no remedy which will remove it with any degree of certainty, although sulphur, camphire, and purgatives have been recommended for this purpose. If therefore the case be urgent, the best way is to let it go on, using the mercurial ointment as above described."
Dr.
Saunders
says he has known patients who have had violent fevers excited by mercury in the form of unction.
The same author remarks, that a gentleman who had recourse to mercurial unction, being seized with a fever, sent for him, and communicated to him his venercal complaints. His pulse was quick and hard, he complained of pain in his back, headach, thirst, and other such symptoms as he had frequently seen arise from a mercurial course, conducted on the plan here prescribed."
Dr.
Cullen
observes,—that purging is never excited by any means, without spasms of the intestines, which, when the operation is continued, are apt to end in durable spasm and inflammation. These are attended with very dangerous consequences. Neither does the method of purging by unction answer much better (although perhaps more effectual), because it is attended with very great pain.—
Lectures on Materia medica.
I have ever found those patients more easily cured, who were most susceptible of the mercurial stimulus. Let there be an affection of the mouth and cheeks, and an amendment of the complaint takes place at least nine times in ten; the mercury will run off in general very soon if the process is discontinued, which it must not be, but the tenderness of the mouth is to be kept up to a certain degree, according to the urgency of the disorder, and to prevent a relapse, especially in chancres with hardness, and in other inveterate cases. It is not the mere quantity of mercury, but the method of directing its operation, which in my opinion is the chief circumstance to be relied on in the cure. I would certainly run the risk, if there was any, of
not immediately curing,
rather than expose my patient to the hazard of a large quantity of accumulated mercury ready at an hour's notice, or less, to emancipate itself from the body by stimulating the intestines, and thus exhausting li
e.
We may be amused with the theory of mercury circulating in the system in perfect equilibrium, not inclining more to one secretion than to another; but it is certain, this is a powerful medicine that ought not to be trifled with; we cannot say to it—So far shalt thou go, and no further. The most skilful pilot will find it difficult so to trim his vessel that it shall not sink or overturn when too heavily laden with mercury.
The ingenious
Plenck,
(to whom the world is so much indebted for the great improvements he has made by his experiments on mercury, and in the cure of this disease) says, that a salivation is a dangerous practice; for the famous
Astruc,
says he, asserts that there frequently supervene, violent fevers, diarrhaea, dysentery, haemoptoe, an immobility of the jaws, and likewise a suffocation, and that too, when a salivation has been most properly conducted; and after him the most skilful
Locher
tells us the same.—
Several years since a practitioner had the misfortune to lose (within a short time of each other) two patients with chancres, for the cure of which he had raised very high salivations by mercurial ointment. Just as their complaints were healed, and salivation began to decline, one of the gentlemen was seized with a dysenteric flux, and expired within a few hours: his death was attributed to a piece of butter which the nurse had inadvertently put into his gruel. The other died also of a flux, arising from the sudden descent of the mercury overturning the equilibrium, and rushing through the patient's bowels with irresistible impetuosity.—
To form a just idea of a salivation, we should perambulate the public hospitals, where there are wretches miserable indeed! miserable in having a sad disease, but much more so in having a cure to encounter which makes the unhappy objects call on death for a deliverance from their pains. Their head, face, and tongue so swelled, as to forbid their uttering a syllable. Their cheeks often torn to pieces, a salivary flux of two or three quarts a day, with breath extremely offensive, teeth loose, tongue and gums ulcerated and inflamed, attended with a severe unremitting head-ach; and this process is the same in all cases and seasons: it may truly be said, such remedies are worse than the diseases they are intended to remove. But this is not all the patient has to undergo; add to this, frequent severe cholicky pains, accompanied with diarrhaea and dysentery, which continuing, so often prove fatal. The patient can swallow no solid food during this severe operation, and indeed scarcely liquids, and is almost dead with hunger, having often an appetite without the possibility of indulging it. Thus are persons confined for several weeks, and when the process is finished, they are so reduced in flesh, as to be quite a spectacle, and frequently go into a deep decline.— If these evils may be prevented, and that they may, we have daily experience added to the strongest testimonies, are we not all called upon by every motive of conscience, religion, and humanity, to preserve the unhappy from ruin, by rejecting so cruel a practice?
"Graviora morbis patimur remedia;
"Nec Vita tanti est, vivere ut possis, mori."
If the surgeons who superintend the hospitals would make a trial of my method, I am convinced from experience, they would be able, without annoying the stomach, to convey any quantity of any mercurial preparation into the system in few hours, instead of weeks. This may be done by rubbing mercury on the back and middle of the tongue, and repeating the process at the shortest intervals. There is no occasion to wait for its operation as in the case of pills, but we may safely stimulate these surfaces as much and as often as we chuse, till we have actually produced the desired effect on the system. Let the mouth be well cleared of the saliva, and I know of no other impediment to the success of this process. Dr.
Home,
professor of physic at Edinburgh, has honoured me by making a variety of public experiments in the Edingburgh Infirmary, which will soon appear in the Doctor's intended publication. By these experiments it is proved, that mercury is more quickly introduced, with greater certainty, and with less prejudice to the constitution in this way, than by any of the other modes of administering it internally or externally.
Objections to Mercury in the Form of Pills, Bolus,
&c.
WITH respect to Pills, it is certain that many patients find a difficulty in taking them. First, it is hardly possible so to distribute the mercury throughout the mass, that there shall not be some difference and uncertainty in the dose when divided into pills; and secondly, they sometimes pass through the body undissolved. When they dissolve, they irritate, perhaps corrode, the stomach, an organ most essential to health. This circumstance has excited universal complaint and dread of mercury, which however being administered in my method, is so very mild, that it does not in the least impair the constitution, as the surface on which the mercury is laid, will bear a considerable degree of irritation without any sort of prejudice.
A grain of mercury applied to the internal surfaces of the mouth is thence absorbed with the greatest facility, and operates kindly and with effect on the habit in general. Dr. Cullen justly observes
Lecture on Mercury.
, "that when we purge, we think we are operating on the common sewer of the system: but little advantage is to be found from the mercury employed in this way, as its virtues depend chiefly on its operation on the body in general."
"The saline chrystals of mercury vellicate and twitch the sensible membranes of the stomach to that degree, as excites them to an excretion of their contents and glandular juices upwards or downwards, according as the force of irritation is greater or less."
—
Mead on Poisons,
"Of all the various modes of administering mercury, that which you recommend seems to me the most safe, and I have no doubt but it will likewise be found the most efficacious. A false opinion has long prevailed, that every medicine ought to be taken into the stomach: this has done much mischief. Many people have such an aversion to medicines of all kinds, that they will suffer any thing rather than swallow a single dose. Others have such a debility of the
Viscera,
that though they can swallow mercury, yet it tears their stomach and bowels to pieces. Of this every medical practitioner must have seen many instances. There are few persons who have been so unfortunate as to take large quantities of this mineral in the usual way, who do not exhibit melancholy proofs of its baneful effects on the stomach and bowels. By your mode of administering mercury, these effects are obviated, while it is much more cleanly and agreeable than the common method of applying it to the skin."
—
Extract from Dr.
BUCHAN'S
Letter.
Dr.
Hunter
observes, "that this process is preferable to pills or boluses, as the calomel stimulates the primae viae much less, and therefore he adds, people with very tender bowels may bear it much better in this form than any other." Therefore it is best for all constitutions, as every person has most undoubtedly tender bowels.
Dr.
Krohn,
in his letter to me mentions the case of a gentleman, "who had a virulent chancre on the
froenum,
of which he was cured in a fortnight by this process, without the smallest inconvenience; on the contrary, he found his bowels perfectly free from any attack on them, the usual attendants on former methods of treatment, which he had frequently experienced previous to this trial."
"How many originally, vigorous, deduce their present weak bowels, and crazy constitutions, from the mischiefs occasioned by the action of the Mercury on the primae viae."—
Mr.
Cruikshank's
Letter.
After ample trial of all the different mercurial preparations in common use, I find that any of them may be safely and expeditiously conveyed into the system from the surfaces of the mouth, and that those of the most subtle and active kind are equal to the cure of the most confirmed disease. Their stimulating quality supplies the place of friction, which is only necessary when any of the milder preparations are employed.
Objections to Mercurial Ointment.
"The friction of Mercurial Ointment is to many people one of the most disagreeable things in the world. It's leaden colour, contrasted with the skin, makes it look dirty. It has a particularly offensive smell, independent of that of the turpentine, or balsam of sulphur, which may have been employed in extinguishing the quicksilver. From the circumstance that half an hour's friction, or even that of a whole hour, if ever so well performed, will not commonly effect a total absorption of the ointment, the skin is generally left a little smeared with it: after the process is over, as it is oily it does not evaporate, or dry readily, and will easily stick to whatever it touches. Patients are obliged to sleep in flannel drawers to prevent the ointment from getting through and daubing the bed clothes. They must be frequently changing these drawers, constantly washing the skin; or, as washing off the ointment would retard rather than forward the cure, they must remain dirty for six weeks, or perhaps three months together; and if by accident any part of the ointment gets upon their linen, from it's colour it is very apt to give the alarm in families, and lead to disagreeable discoveries."
Mr.
Cruikshank's
Letter.
Dr.
Manning,
in his Practice of Physic, on the subject of my mercurial process observes as follows; "By this method we not only avoid the inconveniencies of unction, but the purgative effects that are often produced by mercury when taken into the stomach."
With respect to a regimen in the treatment of the Lues, abstinence and low living certainly retard the cure. Persons afflicted with this distemper, are much subject to despondency, and living more freely now than at other times, raises the spirits of the patient, and contributes to his cure by co-operating with the medicine; therefore I shall continue to recommend that practice, at the same time should object as strongly as any other practitioner, to every indulgence that might be prejudicial. It has been said, that people under a course of mercury cannot be kept too warm, which is true only when the mercury affects the stomach or bowels, or greatly opens the pores of the skin; but from the very mild operation of mercury on the system in my method, patients are exposed to all weathers, without injury to the constitution.
Dr.
Krohn
on this subject says, "this mode agrees better with people who are debauchees, having had essential proof of this assertion in a patient who drank all kinds of strong liquors, was scarcely ever in bed for a week together, till break of day, and was much exposed to cold damp air."
A Recapitulation of Objections to the common Methods of administering
MERCURY,
accompanied with some new Observations, and conveying a short and pointed View of the Whole.
A
Lues
is a venereal infection in the mass of blood; and is to be cured by throwing a sufficient quantity of mercury into the system to expel it.
There are many ways of conveying mercury into the circulation of the blood.
The usual methods are by pills, boluses, and draughts, and also by outward application of mercurial ointment.
The first three are conveyed by the mouth into the stomach, where the mercurial particles are in part absorbed by the lymphatic vessels of that organ, and conveyed into the blood; also by the same vessels in the intestines, and frequently the greatest portion of the mercury escapes out of the body by this outlet, having first irritated the animal oeconomy throughout the whole of the canal.
Mercury may be prevented from passing downwards by joining
opium
with it, which takes off its stimulus, and generally prevents its purgative effects; but this often creates sickness and reaching, and shakes the whole nervous system.
Two grains of mercury taken up into the blood by the mouth, will produce as powerful an effect on the system, as twenty grains thrown into the stomach, on the presumption that eighteen of the twenty make their exit downwards: we reckon only what gets into the system, for what passes through,
is lost,
and certainly better had never been given. The stomach resembles a sink with a grate in it, and is not constructed to retain mercury.
Mercurial ointment cures by being taken up into the blood by the absorbents of the external skin, and when introduced there, by operating on the whole vascular system, and expelling the venereal poison by the different secretions and excretions of the body.
The objections to this mode of practice are, First, that it is dirty and disagreeable; that it is commonly slow and tedious: that it requires too much labour for persons in a weak state, and if the friction is performed by other hands than their own, that one half of the ointment, or more, must infallibly be lost to the patient, and may prove very injurious to the party who applies it.
Mercurial ointment affects the stomach or bowels, and brings on purging; insomuch that it is not uncommon for patients, both in public and private practice, to die under a course of unction, of violent cholies, accompanied by sanguinary and other fluxes, and this happens by the quantity of mercury absorbed proving an overbalance for the constitution.
Practitioners do not accurately know what quantity of mercury may be given, and what quantity of it will take effect, as different constitutions require different doses. Five grains of mercurial ointment will take more effect on one subject, than fifty on another; after using it ten or fifteen days successively, no visible effect may be produced on the constitution; yet, on the eighteenth or twentieth, a salivary flux may commence, and continue for a fortnight or three weeks, and the patient's strength become exhausted. At this juncture should a diarrhaea unfortunately take place, it carries off the patient in a few hours, notwithstanding all the endeavours of the most skilful of the faculty.
I have made use of such arguments as have occurred to me in behalf of this new method, and have advanced nothing but what my repeated experience doth fully warrant. If the ideas of other practitioners do not coincide with mine, I shall be happy to see their avowed and printed sentiments on this important subject, divested of prejudice and delivered with candour.
Should it be asserted that this method sometimes fails, let not that declaration prevent the trying it, as this may be urged against all medical practice, and often, no doubt, with the greatest injustice.
It is said that this process, by shortening the cure and lessening the medicines, will diminish the fee. The profession need not object to it on that account, as they are paid, not for their medicine, this being no object, but for their skill and judgement. Patients of liberal dispositions will always be pleased with dispatch and make a handsome return: and others will find their interest also in behaving in the same equitable manner.
FINIS.
Published by the same Author, in two Pocket Volumes, in boards.
Price 5s.
A New and easy Method of Curing the LUES VENEREA: with an Essay on ABSCESSES, and other observations in Surgery. The 3d edition; to which is added a Letter to Dr.
Buchan,
on the Modern Practice of INOCULATION: also Miscellaneous Remarks by several Gentlemen of the Faculty in favour of the NEW MODE of administering Mercury: with anatomical Plates of the
Villi,
or Packets of Absorbent Vessels.