Observations on the Use of Mercury. 
A. P. MERRILL, M. D. 
REPRINTED FROM THE AMERICAN PRACTITIONER, MA V, 1871. 
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1871. The American Practitioner. 
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LOUISVILLE, KY. Observations on the Use of Mercury. 
A. P. MERRILL, M. D. 
REPRINTED FROM THE AMERICAN PRACTITIONER, MA Y, 187U 
LOUISVILLE: 
Printed by John P. Morton and Company, 
1871. OBSERVATIONS ON THE USE OF MERCURY. 
Calomel is employed in the treatment of fever and some 
other diseases for two distinct purposes, as a purgative and as 
an alterative. In acute diseases a scruple may in general be 
considered a proper purgative dose, and it may be expected 
to operate upon the bowels in three or four hours’ time. When 
it fails to do so in recent attacks of fever, castor-oil or some 
other active purgative may be administered to expedite the 
movement; but it is an objection to the administration of 
such adjuvant cathartics with the calomel that by their more 
rapid action they may carry off a large portion of the calomel 
through the bowels unchanged. When fever is promptly 
arrested by abortive treatment, the patient rarely ever requires 
more than a single dose of calomel, and often not even that; 
but should the disease be suffered to continue, it is not enough 
that the bowels be once cleared of ingesta: the excretions 
poured into them as the result of every returning paroxysm 
of fever must be gently purged away, or they become incon- 
venient sources of irritation, and prolong the disease. An 
idiopathic fever may in this way become symptomatic and 
difficult of cure. Scruple-doses of calomel are often useful in 
such cases, operating less frequently and with less exhaustion 4 
Observations on ike Use of Mercury. 
of strength than smaller doses. Many southern physicians 
give calomel in fever only in this way, as a purgative; and if 
some advantage accrues from the excitation of secretion, it is 
an incidental benefit to the credit of the mercurial purgative. 
Much larger doses of calomel have sometimes been given by 
enthusiastic advocates of the remedy; but it has been proved 
that, unless unduly retarded in its passage through the bowels, 
not more than a scruple is appropriated by the action of the 
organs of digestion, the remainder being mingled with the 
fecal dejections. If the surplus has performed any office at 
all, it is probably that alone of the crude mercury, as used 
in not very ancient times, as a morning aperient, operating 
perhaps by the power of gravitation. 
Opium should not, in my opinion, be given with calomel 
when used as a purgative, for the reason that its action 
upon the digestive organs is antagonistic to that of mercury, 
restraining both secretion and catharsis, and, what is more 
important, tending strongly to the production of ptyalism and 
ulceration of the gums. Besides all this, I have found opium 
exceedingly injurious in the advanced stages of gastric and 
enteric fever. In gastric or yellow fever, except in the early 
or irritative stage, its effects are nearly always fatal. As some 
evidence that this remark is applicable to northern as well as 
southern fevers, I will state that during the present winter I 
went to a distant part of New York City to call on a friend. 
I found him ill with fever of only five days’ duration, and with 
considerable gastric disturbance. He had passed a sleepless 
night, walking up and down his chamber; but his physicians, 
two homeopaths, promised to remedy that evil the succeed- 
ing night by a soporific dose. They were successful. Their 
patient slept soundly, and in the morning was supposed to be Observations on the Use of Mercury. 
5 
better; but at midday he was a corpse. His doctors had not 
learned one of the great features of gastric fever, and in their 
zeal for success they had ventured to stray away from infini- 
tesimalism. 
Calomel is also used in fever, as in other diseases, as an 
alterative, a necessity for which is supposed to have been 
created by the progress of the disease; and then it is almost 
uniformly given in conjunction with opium, with a view to re- 
strain catharsis, and sometimes to secure ptyalism. Smaller 
doses, repeated several times a day, are generally given ; but 
much caution is required in conducting this treatment. As 
long as there is great febrile excitement it is difficult to 
produce ptyalism ; and when such excitement subsides, the 
action of the mercury upon the gums and salivary glands 
may become excessive, and lead to troublesome ulcerations. 
These are the mischievous effects which have brought mer- 
cury into discredit with many persons, and given support to 
systems of charlatanry. My own experience justifies the 
opinion that equally good results, without danger of purgation 
or salivation, may be secured by giving the calomel in smaller 
doses, and without opium. I have generally given preference 
to half-grain doses, but sometimes have found it expedient to 
give a full grain. Quite as often, however, I have reduced 
the dose to a fourth of a grain. The power and efficacy of 
calomel given in this way can not be appreciated except by 
those who have tried it. As an occasional aperient dose it is 
invaluable; and in some forms of chronic disease a half grain 
of calomel may be taken every night, with benefit, for weeks 
and months together. 
> 
Corrosive sublimate is sometimes to be preferred to calo- 
mel as an alterative and aperient, and especially in those 6 
Observations on the Use of Mercury 
forms of indigestion dependent upon a want of tone in the 
stomach and bowels, accompanied by a want of healthy action 
in the liver and kidneys. It is also better suited to the treat- 
ment of most catarrhal affections. The medium dose may be 
set down as one eighth of a grain, which may be given daily 
with even less danger of salivation than from the use of calo- 
mel in half-grain doses, conditioned always upon the exclusion 
of opium. These two forms of mercury, given in small doses, 
are, it seems to me, better adapted to the young and the aged 
than to those in the full vigor of life. The newly-born babe, 
if it must take medicine at all, is better treated by calomel or 
corrosive sublimate, in suitable doses, than by the remedies 
so much relied upon for their reputed mildness of character; 
and many old people, whose constitutions are well worn by 
use and abuse, find great relief by the habitual use of calomel 
or corrosive sublimate in proper quantity. 
The use of mercury as a remedial agent is a trite subject 
upon which to write an essay; but I have made these brief 
remarks for the purpose mainly of suggesting the important 
difference between the purgative and the alterative use of 
mercury, especially in the treatment of fever, and the neces- 
sity of avoiding the simultaneous use of opium, if it be an 
object to prevent ptyalism. I have deemed it proper also 
to recommend the more general use of corrosive sublimate 
as the mildest in its medicinal effects of all the forms of 
mercury, and the least likely to cause salivation. I venture 
to express a doubt indeed whether the materia medica affords 
us a milder and safer aperient. I generally give it in form of 
pills, as solutions are liable to decomposition. 
Calomel deserves to be more highly appreciated as a top- 
ical remedy, especially in diseases of the dermatoid tissues; Observations on the Use of Mercury 
7 
in ulcerations of the mouth, throat, and nasal passages; in 
purulent ophthalmia and lachrymal fistula; in hemorrhoidal 
affections and fistula in atio; in excrescences upon the genital 
organs, sometimes mistaken for syphilitic ; in sinuses, fistulas, 
and ill-conditioned ulcers; in burns, abrasions, and excoria- 
tions ; in a great variety of cutaneous eruptions; in certain 
cutaneous excrescences, mostly of the face, often treated by 
charlatans as cancerous; in encysted tumors, the contents 
of which have escaped; in surgical operations involving the 
mucous membranes, the secretions of which interfere with 
the healing process, etc. Dry calomel is generally to be pre- 
ferred ; but in positions where it can not be easily retained it 
may be incorporated with castor-oil or with glycerine. Little 
skill is required in its application superficially; but in fistulas 
and deep-seated ulcers a quill or tube may be used, from which 
the powder is extruded by a piston. Salivation is rarely pro- 
duced by this topical use of calomel, except in ulcers of the 
throat and nasal passages, whence the remedy reaches the 
stomach. The quantity of calomel sometimes used topically 
without the production of ptyalism shows the amount of 
absorption must be small. In a case of ruptured wen upon 
the arm of a negress, twenty grains were inserted into the 
cavity for twenty successive days, and a smaller quantity for 
several days subsequently; and I have known even more than 
this used in cases of fistula in ano without evidence of con- 
stitutional effects. 
Without extending these remarks, I hope I may have suc- 
ceeded in exciting renewed interest in the uses of mercury, 
and in giving some hints in regard to its abuses. By occa- 
sional discussion it may be hoped indeed that the medical, 
and to some extent the public, mind may be disabused of 8 
Observations on the Use of Mercnry. 
unfounded prejudices against mercury, and made to under- 
stand the discriminations to be made between its cathartic 
and its alterative use. Without such discrimination much 
that is written, especially on the subject of treating febrile 
diseases, is unmeaning and unintelligible. As prejudice is 
overcome, the topical use of calomel may be more generally 
understood and appreciated; superseding to some extent the 
troublesome seaton, the painful escharotic, and the reckless 
and bloody knife. 
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CONTENTS FOR MAY, 1871. 
Original Communications : 
Will Quinine Originate Uterine Contractions? By L. A. Sayre, M. U. 
Observations on the Use of Mercury. By A. P. Merrill, M. D. 
Iodine Inhalations in Diphtheria. By Geo. II. Eyster, M. D. 
Sudden Death of an Applicant for Life Insurance. By S. M. Bemiss, M. I). 
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