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NEW ENGLAND MEDICAL GAZETTE.
(For the Gazette.)
THE DISTINCTIVE MERCURIALS.
Part of a lecture delivered in the London School of Homœopathy, Dec. 9, 1878.
BY RICHARD HUGHES, M. D, LONDON, ENG.
HAHNEMANN, when in the proving of his own black oxide he had supplied the pathogenesis of mercury as such, proceeded (in the "Reine Arzneimittellehre") to give some suggestions as to the action of other and more distinctive mercurial preparations. He furnishes one symptom as produced by calomel, fiftyone as from corrosive sublimate, twenty from the acetate, two from the red precipitate, and forty-five from cinnabar, — all of these, save a few of those of the sublimate, having been observed by himself. He concluded with one hundred and sixteen symptoms taken from authors, descriptive of the effects of "miscellaneous mercurial medicines," including those of inunctions and fumigations. I have followed him in speaking separately of mercury, as such, but have included under that heading the influence exercised by pure quicksilver in every form as well as by its non-irritant salts. I have now to speak of its more distinctive preparations, which will include the bichloride, the cyanide, the iodides, the red oxide, and the sulphide.
Mercurius corrosivus the bi- or perchloride of chemistry hitherto, the mercuric chloride of present nomenclature, the corrosive sublimate of common language-is, as you know well, a most potent poison, and in our hands is a most valued medicine. It is prepared by trituration, or solution in rectified spirit. Besides Hahnemann's symptoms obtained from it, and Dr. Buchner's provings of it (in fractional dose) on himself and
VOL. XIV. NO. I.
seven others, Dr. Allen adds numerous effects of poisoning, making a pathogenesis of upwards of eleven hundred symptoms, which we may supplement yet further by using the observations made by Lewin in the treatment (on a large scale) of syphilitic disorders by the hypodermic injection of the drug*
Corrosive sublimate is, of course, a mercurial, and therefore capable of inducing the constitutional effects of the metal; but these are by no means readily obtained from it, and no mercurialist in the past ever used it to cause salivation. We, in like manner, should be chary of employing it as a remedial agent in conditions answering to those of pure mercurial influence, preferring for such purposes the M. solubilis or vivus. But M. corrosivus has a sphere of its own as a specific irritant to the living tissue, in which for range and intensity it is rivalled only by arsenic. It affects in this way the stomach and large intestine, the respiratory mucous membrane and the lungs, the kidneys and external uro-genital organs, and the peritoneum. I will speak of each action, and of its therapeutic applications, separately.
1. Upon the alimentary canal the sublimate acts, when swallowed, as a corrosive caustic, chemically destroying the mucous membrane, wherever it comes in contact with it; but observation and experiment show that when otherwise introduced into the system, it still exerts an irritant influence upon certain parts of the digestive tract, which influence must, therefore, be of an electric and dynamic character, and suitable for homoeopathic application. The parts so affected are the mouth and throat, the stomach, and the large intestine.
The best observations of these actions are those of Dr. Lewin, as his doses were moderate ('% to 3 of a grain) and his experiments extensive. He found mouth affections in thirty-five per cent of his cases. They consisted either of slight stomatitis and moderate ptyalism, with some tenderness and swelling of the salivary glands, or of stomatitis ulcerosa, the ulcers being covered with a dirty yellow coat, which he compares (hardly justly, I think) to a diphtheritic membrane, without ptyalism, or of pure
*The Treatment of Syphilis by Subcutaneous Sublimate Injections. By Dr. George Lewin. Translated by Dr. Proegler and Gale. Philadelphia: Lindsay & Blakiston. 1872.
increase of the flow of saliva, of unchanged quality, and without any evidence of inflammation. If the patients caught cold, they had redness and swelling of the tonsils and neighboring lymphatic glands, hypertrophy of the former being no uncommon effect of a prolonged course of injections. Gastro-enteric symptoms were observed only when the maximum dose I have mentioned was overstepped. "In lighter cases, the intoxication was ushered in by gastric disturbances, like anorexia, coated tongue bad taste, sometimes metallic, yet but seldom does the patient complain of nausea and vomiting. After a little time, pain of a sharp, burning character is experienced, a symptom which manifests itself not only spontaneously, but by pressure on the abdomen, especially in the region of the stomach and right hypochondrium. A little later, diarrhoea commences, tinged with blood only when occurring profusely. The patients present a markedly pale appearance, and complained of great langour. After the injection. of relatively larger doses, the symptoms were aggravated, patients generally complaining of a vertiginous feeling, and after walking a few steps they would feel obliged to seize hold of something for support. . . . With the already painful affections of the abdomen, vomiting occurred, sometimes with bloody dysenteric stools and tenesmus." I need hardly remind you that similar phenomena are observed in acute poisoning by the sublimate, and post-mortem investigation, while showing all the signs of inflammation (including those of dysentery), finds them limited to the stomach and large intestine, the smaller bowel remaining intact.
Quite in accordance with these facts is the use made of M. corrosivus in homoeopathic therapeutics. In affections of the mouth and stomach, indeed, it is not much employed, though Hahnemann recommends it (fifteenth dilution) in "very malignant, obstinate stomacace, arising after debilitating, prostrating diseases"; and Dr. Pemberton Dudley esteems it highly, in the second and third decimal triturations, in chronic gastric catarrh, with distension and soreness of the epigastrium and of the transverse colon; but when the large intestines are affected, whether with simple inflammation, with chronic ulceration, or with dysentery, its effects are amongst the most brilliant things in medicine. Hahnemann was the first to recommend it in dysentery, saying (in 1822) that he had found it almost specific in the common
autumnal invasion of the complaint. He gave the fifteenth dilution in single dose; but Dr. Ringer reports correspondingly good results with hourly-repeated doses of a hundredth of a grain. All homœopathists, whether high or low dilutionists, concur to praise it here, and though some would limit its use to a certain variety of the disease, we have Dr. Espanet saying, "In the numerous cases of dysentery which I have treated in Algeria, I have never found the least advantage from substituting for M. corrosivus another remedy which seemed more homoeopathic to the febrile phenomena or the abdominal symptoms. Dr. Fenith, of Algiers, has made the same remark." *
2. Corrosive sublimate inflames the respiratory mucous membrane of the eyes, nose, and bronchi, and also the lungs. It is highly esteemed in strumous ophthalmia, as you may see by referring to the cases reported by Dr. Böcker in the third and Dr. Kidd in the twenty-second volume of the "British Journal of Homœopathy." Predominance of inflammatory and ulcerative symptoms call for it here, with great photophobia and profuse acrid discharges. Drs. Allen and Norton warmly commend it in syphilitic iritis and choroiditis, and in albuminuric retinitis. Dr. Jousset, and with him Dr. Dekursmaccker, treats purulent ophthalmia by instillations of its third decimal dilution. It should be serviceable in the bronchitis of Bright's disease and in syphilitic phthisis (i. e., chronic pneumonia in these subjects).
3. The kidneys are very much affected by this poison. Suppression of urine is a very common phenomenon, and post-mortem investigation shows it to be connected with acute congestion or inflammation of the secreting structure of these organs. The urine is albuminous and bloody during life, in one case (cited by Allen) "presenting granular, fatty tubuli in large numbers, showing on their surface epithelial cells of the tubuli uriniferi also in a state of granular degeneration," and the patients die with all the symptoms of uræmic poisoning. Lower down we have frequent and painful micturition, and sometimes swelling of the penis and scrotum, with blackness of the latter, and intense inflammation—even to sloughing of the vulva.
M. corrosivus is considered by Dr. Ludlam the best remedy
* Bulletin de la Soc. Med. Hom. de France, XIX. 179.
for the albuminous nephritis of pregnancy, and is commended by Baehr in nephritis suppurativa. Dr. Yeldham gives it in alternation with aconite, in the first stage of gonorrhoea. I have mentioned its usefulness in phagedenic and sloughing chancre; its homœopathicity thereto is now manifest.
4. Inflammation of the peritoneum and effusion into its sac is a frequent feature in poisoning by corrosive sublimate; and there is reason to suppose that it has a similar influence on other serous membranes. The cerebral arachnoid has been found inflamed by it, and Allen's 883d symptom suggests the spinal arachnoid as in the same state: "Loss of power and stiffness of the extremities, gradually increasing day by day, with excessive pain on any attempt to change the position, until the patient becomes entirely paralyzed."
I have myself the highest esteem for M. corrosivus in peritonitis. I have used it here even more frequently than bryonia, and with most gratifying results.
Besides these more obvious applications of the peculiar properties of M. corrosivus, it has been used in homoeopathic practice in several important disorders, as by Dr. Lawrence Newton in ulceration of the cartilages of the joints,* by Jahr and Hofrichter in syphilitic exostoses,† and in the eczema impetiginodes of scrofulous children. The discovery lately made by Dr. Rutherford and M. Vignal, that it alone of the mercurial preparations is a true cholagogue, may possibly lead to further applications of it as an hepatic remedy. For the present, I must say no more of it.
(To be continued.)
PHYSICAL SIGNS IN OUR MATERIA MEDICA.
BY HERBERT C. CLAPP, M. D., BOSTON.
In looking over our Materia Medica with special reference to finding physical signs, one can hardly fail to notice how conspicuous they are by their absence. When present, they are so vague as to be practically worthless as guides for treatment. As
* Monthly Hom. Review, XIV. 543.
† Jahr's "Venereal Diseases," translated by Hempel, p. 412.