UNITED STATES OF AMERICA ^ . . FOUNDED 1836 WASHINGTON, D. C. OPO 16—67244-1 A DISSERTATION ON THE SALUTARY EFFECTS OF MERCURY, IN ^lalfgnant fz^txs Br JAMES STi'AP.-: ■ J NATIVE OF VIRGINIA, AVE R£S!.E*T MF.id! '.< OF fBf > ^ ACADEMY OF MEDICINE OF PHllADEll 'A. Pnepetibus pcnnis aufusfe credere czelo: Infuetum per itergelidas enavit ad ar&os. Firg. JEntid VI. Ne meadonatibi Audio difpofta fideli, Intellecta priufc[uam fint contempt* relinqua. Lucret. Lib. T. PRINTED BT THOMAS & SAMUEL F. BRADFORD N». 8, SOUTH FRONT STREET l798. A N SUBMITTED TO THE EX AM IN A? IOM OF THE Rev. 3fi$tt Ctottlg, S. T. P. Provost: THE TRUSTEES AND 9©eDical jracuttg OF THE UNIVERSITY of PENNSYLVANIA, FOR THE DEGREE OF Doctor of Medicine, ON THE 22nd. DAY OF MAY, 1798. 3197SQ TO Dr. FENWICK FISHER, OF THE g>rate of ©trgtnta, AS a public teftimony of ef- teem and gratitude for his many kind, offices as a friend and diligent pre- ceptor in the fcience of medicine, This DiflTertation is infcribed, By his refpe&ful friend, And former Pupil, The Author. TO Benjamin 3&uO)f m. d. TROFESSOR OF THE INSTITUTES AND PRACTICE OF PHYSIC, AND OF CLINICAL MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA. Permit me, Sir, thus publicly to return you my fincere acknowledge- ments, for your many polite fervices as a private friend, and for the nume- rous advantages derived from you, hi your public capacity, in this Univerfi- ty, and at the fame time, be pleafed to accept of unfeigned wifhes for the continuation of your health and wel- fare, from your Obliged friend, And very Humble Servant, THE AUTHOR, INTRODUCTION. |F any Medicine from general utility and acknowledged virtues in relieving the miferies of humanity, demands the exclufive attention of the Phy/ician, that fnrely is tbc one which I have chofen as the fubjefl; of this effay. Mercury has not only eliminated the Venereal Vi- rus, humbled the obftinacy of Dropfy, broke the enchantment of Epilepfy, and fnbdued an innumera- ble hofr, of difeafcs, equally inimical to life, but now compels malignant fevers to own its fway. To do juftice to the Merits of this hero of the Materia Medica, and to point out its excellencies in the cure B INTRODUCTION. of every difeafc in which it has been fuccefsfully employed, would require more time than I, at prefent, can take up, and extend this Treatife to a length beyond what is generally amVned to an Inaugural Differta- tion. I (hall therefore confine myfelf to treat only of its falutary ef- fects in what have been termed pu- trid, or malignant fevers, and in ac- complifhing this, the fubjecr. will be divided into four heads. i. I (hall define the term Malig- nant, and offer a few remarks in proof that all difcafes are equally Malignant in proportion to the prevailing In- flammatory Diathejis. n. I (hall confider the Modus Operandi of Mercury when applied to the Syftem. INTRODUCTION. in. The different modes of ap- plying it and the feveral means of aflifting the operation. iv. And Last. The treatment of the Mouth during a falivation; and the remedies for checking it, and the objections from injury to the Teeth and Conftitution. If in treating of fome of thefe par- ticulars, the benevolent reader fhould perceive me ftepping afide from the beaten track of bis preceptor, and be inclined to affociate his cenfure with my name, I earneftly folicit his in- dulgence, and beg him for a moment to fufpend his conclufions until he reflects that when the animal econ- omy is under a morbid ftimulus, it is in proportion to the force of that INTRODUCTION;. ftimulus, infenfible to all others : hence the almoft aflonifhing dofes of opium, daily exhibited in Tetanus, would prove fatal to the fame per- fun while und^r the influence of on- ly the ordinary ftimuli of health; I fymptoms depend on a putrefcent (late of the fluids,* but fince modern experiments have pro- ved, that fuch a ftate in the living body can ne* ver take place,f the term has given place to the lefs exceptionable one of malignant, and lately * vid. Cullin's firft lines Sed. -;z. •\ Dr. Sybert's In?, i jural Difi'ertztior ( * ) to the Gangrenous flate of fever.J The term malignant probably arofc from the ferocious, or malignant countenance of the patient, obfcrvable in thi3 ftate of fever. A cafe is faid to be more or lefs mahVnant in proportion to the violence of thefe fymptoms, and as a greater or lefs number occur in the fame time and patient; but, unfortunately nei- ther writers or practitioners have been fo unanimous in their opinions or practice, of the proximate caufe, or in their methods of cure in this flate of fever. Hence Sydenham complains of the practice of his cotempories, " Cum in " eaas febres prefertim Malignas dicantur, in " quibus intenfioris pras ceteris imflammationis " gradus confpiciatur, hinc medici fe ad ufum t( cardiacorum, et alexipharmacorum nefcio " quorum contulerunt, quo fcilicet per cutis " poros expeilant, quod fomneant venerium " (hoc enim eft dicendum, nifi malint verbis " ludere, quam illud quod poteft intelligi, ferio " proponere"! ex quo factum efi: ut regimen « calediflimum, methodumque hi.ic parem, iis * morbis adaptaverunt, quss frigidiiTmia turn % Pr, Rufli's proximate C?i.fes of Fever. ( 3 ) " remedia, turn regimen, prse ceteris fibi " poflulabant. That malignant fymptoms depend upon an Inflammatory Diathefis, or great cxcefs of fti- mulus, I infer, i. From the fame remote and exciting caufes which produce inflammatory fevers, when ap- plied in higher degree, producing the Malig- nant flate of fever. Hippocrates in his Epidemics mentions a cafe of putrid bilious fever being brought on from the ftimulus of a Cauftic, and Dr. Boerhaave in his definition of a Synochus fays " it has " been cuftomary to call that difeafe a putrid " Synochus, (i. e. a malignant fever) which " arifes from the more violent caufes of Inflam- " mation." And his commentator Baron Van Swieten, under the fame aphorifm confiders, " a high degree of ftimulus the exciting caufe ." of all malignant fevers." 2. From the effects of blood-letting in this ftate of fever, for an account of which as I ( 4 ) have nothing to add, I beg leave to refer to Rr* Rufh's defence of blood-letting. 3. From the facility with wMch trs inflam- matory and malignant Mates of fever are chang- ed into each other* Dr. Hucfc, in his remarks on the fevers of Jamaica fays, " It often depends upon the mm- " ner in whirh the patient is treated in the " beginning, whether he fhall have a yellow " or only a remitting, or intermitting ft-ver," and a cafe is recorded in the Medical Eflays to this purpofe, a—Girl, who was afflicted with a Tertian, took a draught of fpirit of wine, hot ale and ground pepper, and in confe- quence was feized with a violent continual fever; but, when the continual fever went off, the Tertian returned with great irregu- larities, attended with the mod obftinate and malignant fymptoms. In further proof of this, I will relate a cafe that occurred in my own practice. In Anguft, 1797, a young man was afflicted with a Quotidian, attended with dy- fenteric fymptoms, and was cured by fmall bleedings, calomel and opium ; a few days afterwards, the Quotidian returned without any ( 5 ) dyfenteric fymptoms, but he unadvifedly took large dofes of laudanum, and drank hot fpiced brandy (with a view, as he faid, of fweating off his fever) by which means it was accended to a high degree of malignity, the dyfenteric fymptoms returned, and he died yellow with fymptoms of a mortification of the inteflines, on the fifth day from the commencement of tha continual/form. Whilft on the other hand, it is equally certain that the moft malignant flate of fever may be changed to that flate where fizy blood occurs, and finally, that may be reduced to the diathefis which conftitutes health by no other means than a perfeverance in the antiphlogiftic remedies. In confirmation of which I refer to authors who have employed blood-letting as a remedy in thefe fevers*. 4. From all fevers, under certain circum- ftances affuming fymptoms of the highefl ma- lignity. The fmall-pox, for example, in a good con- -itution and under proper treatment, is acknow- .* Botr.lus, Sydenham and Ruih. c ( 6 ) Hedged to be uniformly a mild inflamma- tory fever; but, by a hot regimen and the abufc of ftimulating medicines it may be afcendedtoa grade of malignity equal to the plague, hence in Minorca, before the nature of this difcafe was well underftood, the mod of thofe who fur- vived an attack, remained blind, confumptive, or lame, with caries of the bones, fordid ulcers, &c. fo that Mr. Cleghorn juftly confidered it to approach in violence the plague.* The fame remarks are applicable, only in a lefs degree, to the Putrid Sore Throat, the Pleurify, Rheu- matifm, Gout, Meafles, Influenza, Dyfentery, Scarlet Fever, Puerperile Fever, J.iil Fever, &c.f for a particular account of which, I refer to authors who have profeffedly treated or: each of thefe difeafes. Galen was long fince acquainted with this relation between the inflammatory and malig- * Cleghorn's account of the difeafes of Minorca, p. 2,77. •J- InMn. Jeffrey's cafe, near the New Market, l_ft autumn, fymptoms of malignity attended a difficult and excesfive difcharge of the menfes. She was relieved by feveral bleedings at the arm and the ufe of calomel joined wi'.h frictions of mercurial ointment on the region of the uterjs which excited a. gentle affeftion of the mouth ; the blood was at firtt florid without a difpofuion to feparate,and at thefecond b'.e^lln^ it be- came fizy. ( 7 ) nant Hate of fever, and faid " that fymptoms of " malignity or putrefaction only varied-as nature " overpowers the difeafe, or is herfelf overpow- " ered, and that in inflammations fhe overpow- " crs the difeafe."* This opinion, although not in the language of the prefent day, is very em- phatically expreflbd, as in cafes of malignity the excitability of the blood-veffels is proftrated from excefs of force, nature may be faid to be overpowered j-f- in what die calhrd inflammato- ry fevers, attended with fizy blood, &c. ftimuii have been applied only adequate to excite the higheft convulfive action in the blood-veffels, and lefs than fufficent to induce paralyfis, rup- ture, effufion, &c. and here, nature may properly- enough be faid to overpower, as fhe is flill ca- pable of reflecting the force of ftimuii. After what has been faid, I fhall define a malignant fcv:r to be that Jlate offerer in which there is ever act ion in the blccd-vejels, or a defeft of * De februm differentia, lib. i. cap. vii. chart, tern. 8, p. 115. f Omnia hsc exinde tantum procedere, quod riatura a primo morbl impetu quafi oppreffa, devinctaq : non fatis »ulida eft ut fymptomata rcgularia et magnitudini morbi confona exarferat; omnia vero phenome- na prorfus funt anomala. Etenim perturbata cconomia animali, eC quafi difgeda, febris exinde deprimatur, quae obtinente genuino natu- ral duftu, vigere folet. Sydenh. Schedul. Monit, dc Novae i%\xh Ingteffu, p. 541 etpaffim. c. 8 ) atlion and a difpofition to paralyfis or gangrene, from great cxcefs of ftimulus. Thus, Regulus, after loofing both his eye-lids and a long con- finement in a Carthagenian dungeon, uponfud- den cxpofure to the rays of a meridian fun, muft have been in the midft of darknefs from the cx- cefs of furrounding light. II. THE MODUS OPERANDI OF MERCURY, WHEN AP- PLIED TO THE SYTSEM. i. As an evacuant of Fceces, Bile, Mucus, and Lymph. To any one who confiders the great degeneracy of fome, and the increafed quantity and vitiated quality of others of thefe fubftances in malignant fevers, the neceffity of immediately difcharging them will be fufficiently obvious, and accord- ingly, moll prudent phyficians have been anxi- ous to excite ftools as foonas the circumftances of each particular cafe would admit of, but gene- rally with an intention of preventing an accu- mulation of putrid matter, and thereby obviating any farther acceflion to the putrid ferment, on which this flate of fever is fuppofed to depend) C 9 ) but, in effecting this, from an apprehenfion of inducing a fatal debility, they have moflly con- fined themfelves to the ufe of purges of the mildeft nature, fuch as the neutral falts, Senna, Manna, Creamor Tartar, £:c. but, fince this fuppofed putrid flate of fever has been proved to depend upon excefs of ftimulus, and fince the application of a cauftic* eating of a pnvticu-. lar kind of fifh,f and large dofes of opium| have each been known to produce the fame alarming fymptoms as are occafioned by what are generally called putrid contagions, this in. tention of cure proves to be badly founded and is to be changed for the more rational one of abftracting from the fum total of ftimuii. Thefe matters are often fo acrid as to excoriate the rectum and the fkin of the external parts. When long retained they prove a nidus to contagion, and concentrate it when already prefent. By mechanical preffure, from an accumulation of fceces in the large interlines, the capacity of the veins are diminifhed, the pafiage of the fluidi through the fmaller arteries is ftraitened, and a larger quantity of blood thrown on yitsl parts* * Hippocrates'Epidemics, bcokiy, -J- Defportes. % 'Rufiu ( io ) Both evacuations and dhTeelionsfhew the en- creafed quantity and vitiated quality of the bile, which takes place in fome of thefe fevers. Mr. Cleghorn mentions vaft quantities of this fluid difcharged in the- malignant Tertian of Minorca, and I have feen nearly two quarts evacuated in the fnort fpace of 24 hours; ray own cafe in the bilious yellow fever of 1793, exhibited fully an equal quantity, it was fo acrid as to ex- coriate the faucn, tongue, Jjps, and anus with the external fkiii wherever it touched. Dr. Phyfick's hand was inflamed by the acrid matter found in the gall bladder and primsvias in diffec- tions made in this city, in the yellow fever of the fame year. The Doctor fuppofed this matter found in the interlines to be an altered fecretion from the liver. Mr. Cleghorn diffected nearly one hundred bodies that perifhed by the malig- nant tertian at Minorca, and fays healways* found the VefficafelleaiwW and turgid and the ftomach and Inteftines overflowing with bilious matter. But, notwithftanding the large fecretion of this fluid that takes place in fome of thefe fevers, cafes occafionally occur, in which it is intirely abfent, in which the fceces firft difcharged are white and float on the furface of the water like light wood, and in all other refpects are fimilar to thofe accompanying the jaundice. Dr. Chi- fholm takes noiice of their appearance in the fever of Grenada in 1792, and they frequently occur in the yellow fever, accompanied with great anxiety and forcnefs in the region of the liver j it is a fymptom of dangerous prognofis, as it fhews fuch an ingcrgcment of the veflels of that organ as threatens an immediate paralyfis or gangrene. This opinion is confirmed from the large quantities of bile and the relief afforded from the exhibition of purges which have a fpe- cific operation on the liver. From theprecedingobfervationsandthe diiTec- tions cited, it would feem that the matter f,:i:nd in the inteftines was always merely a vitiated fe- cretion from the liver ; but from fome experi- ments made on the black vomit difeharged in the yellow fever of this city, in 1797,1 am fatis- fied that this is not always the cafe, and that its fources are frequently various. In four in- llances I touched the tip of my tongue with feme of this matter ; in three of thefe cafes there was fome difference of appearance. The firft, at a fmall diftance, very exactly exhibited the colour and confiftence of Coffee grounds; but, when more clofely infpected, the fluid part was cf a dark greenifh colour, and the lumps brownifh ( t2 ) and loft. It imparted upon its fir ft application to the tongue, an intenfely bitter and a very naufeous tafle, in about half a minute a prick- ing fenfation was perceived, which I can com- pare to nothing but that excited by the fine prickles of the prickly pear. The patient who difcharged this matter, had vomited and purged bile early in the difeafe, and died on the fifth day from the attack, foon after I firft faw her. In the fecond Cafe the difcharge came on the feventh day of the' difeafe, and at a fmall dif- tarice was fimilar to the former; it was found to be brownifh, or rather of a chocolate colour, and extremely naufeous in fcent and tafle, but it did not produce the laft fenfation on the tongue. This patient had a hemorrhagy from the gums, and the ftools were fimilar to what was Vomited up : fhe recovered after lying three days under this difcharge without any percepti- ble pulfe. In the third cafe, the matter was dif- charged by a child about four years old, on the fifth day of the difeafe. She had white flools throughout the whole courfe of the diforder, and on the two firll days nothing was difcharged by vomit, but mucus and the liquids drank, fhe WasJ early comatofe, and difcovered great anx- iety on being roufeJ \ on the third day, the ( -3 ) mucus became ftreakcd, with a greyifh colour, as if a fmall portion of afnes had been ftirred in it, but on the fourth and fifth days, very dark, although upon a nicer examination, it was ftill ftreakcd with phlegm. This difcovered, on ks firft application to the tongue, neither tafle nor fmell; but, in a fhort time excited the fame pricking fenfation as the firft. In both the firft and third of thefe experi- ments, fmall pimples came out on my tongue, in a fhort time, and difappeared in about ten or twelve hours. From thefe fads it appears, i. That the black matter difcharged from the ftomach and inteftines, in fome of thefe fevers is often of different properties, and is to be re- ferred to different fources, 2. Ihat it is not always neceflarily a fatal fymptom, and that when it takes place, the probable iffue of the difeafe may be prefoged from the knowledge of its fource. The firft matter which I have noticed, from its greenifh colour and bitternefs of tafte, may be confidered as an altered fecretion from the liver, with a mixture of blood from the eroded D ( 14 ) veffels of that organ ; I refer its fource to dir- organization, and from this caufe it muft be neceflarily a fatal fymptom.* The fubject of the fecond experiment from its late occurrence, from the hemorrhagy from the gums which attended, from its intolerable flench, from its want of acrimony, and more efpecially, from the frequent recoveries which take place after its occurrence, muft have been grumous blood, iffuing by diapedefin or rupture immediately into the flomach and interlines or fwallowed from the mouth. The laft, from the gradual changes it went through in acquiring a dark colour, from its mixt heterogenous appearance, from the abfence of a bitternefs of tafle, from its want of fnrell, and laftly from the difcharge of white flools through the whole courfe of the difeafe, I refer to an altered fecretion from the arteries of the ftomach, which, in a healthy flate, were wont to fecrete mucus and the gaftric * Dr. Rufh mentions two patients, which recovered from the Yellov* Fever or 1793, af.er difcharging black matter, on the firft day of the difeafe, but as no mention is irade of the lumps which give, i: what ha* been called the Coffee ground afy'.Ih and from hii own rrn.arks. r con- clude it muft have been nothing more than a dan*, bile, without any coll.» of the part from whence it was vlciivei. ( >s ) fluid.* Poflibly cafes may and do occur, in which all thefe fluids are prefent in the primes vise, at a time; but, from a determination of the fluids to any particular part, being known in fome degree to exempt other parts from injury, fuch an occurrence muft be rare. It may be faid in contradiction to this remark, that in cafes, where the difcharge indifputably pro- ceeded from the liver, di flections have fhewn the ftomach and interlines in an inflamed or even in a gangrenous flate; but, this was the effect of matter externally applied, which is known to deftroy fecretion, and from the imme- diate diforganization of the veffels, no difcharge afterwards takes place until Houghs are caft off, which as coming from living and healthy veffels, muft be always bland and inoffenfive ; this is illuftrated from the effects of a cauftic ; the part to which it is applied, firft contracts and fqueezes out the lymph before contained in its veflels, a flough is then formed, upon which all further difcharge ceafes, until that is caft off. * " The blood is here fo much refolved, that before death it enters *• the fmalleft fcrous veflels, tinges the faliva and the ferum difcharged " by a blifter, and by oozing into the Stomach gives that blackiih caft '* to whatis then thrown up." p :njle'sDifeafes ofthe army, p. it;-7' ( It?) The yellownefs of the ferum in thc'c fever;, has been fuppofed to depend upon bile in its compound ftate, but, experiment has convinc- ed me that this fuppofition alfo is erroneous. In a cafe of Yellow Fever laft autumn, I tailed the ferum taken when the patient was very yellow; it was unufually faline, but without the leaft bitternefs of taftc. A few days afterwards, I made the fame experiment on the ferum, from the blifters of an i»51ciitious patient, which was the yelloweft I ever faw, but not in the leaft bitter, nor unufually faline. The acrimony of the hu- mours therefore, altho> the colouring matter of the bile is fo eminently confpicuou-, does not depend on the prefence of that fluid in a com- pound ftate, but upon the acquifidon of an en- creafed proportion of falts. I have been the more particular in this di^rcf- ficn, not only with a view of elucidating the operation of mercury, in the cure of this ftate of fever, but, becaufe the difcharge of the Black Vomit, is fo ftrongly affociated with the death of ' the patient, as the inevitable confequencc , that he is commonly defcrted both by phyficians and attendants upon its firft appearance, and often, ( >7 ) when by a perfeverance in proper remedies, life may be preferved* I now come to mention in a fummary view, the feveral good effects of mercury in evacuating the different humours, which havebeen noticed to be prefent in the firft paffages in this ftate of fever. 3. By evacuating them early in the difeafe, any farther encreafe of acrimony is prevented. 2. The generation or concentration of conta- gion is prevented by the fame means. 3. The ftimulus from the mechanical p"effure of hardened fceces is removed, the capacitv of the veins of the larger inteftines is increafed, and a revulfion from vital parts effected. 4. An accumulation of bile is prevented and its regurgitation into the ftomach. * This took place in a cafe which I have mentioned in another part cf this Eflay. A gentleman of refpeclability in his profeffion was called on at the firft appearance of this difcharge, in confutation with me. Up 3 a feeing the matte*, he pronounced her irrecoverable, I told him, I fuppof- ed it confined of blood, and was sot the refuk of difor^aniz^tion, he an- fwered, that if I thought fo, he mould leave her in my care, as he did no: Uiink it worth while to take her cafe into confideration, and went away without any other propofals. As the p;.t;:.:t recovered; the truth of my fufpicions v.;.s cosfirr.:'.-i. ( >8 ) 5. The white colour of thefceces is changed, the anxiety and oppreflion attending are reliev- ed, and the yellownefs of the fkin prevenced. 6. From its fpecific action on the hepatic fyftem* the ftimulus of contagion is fuperceded, congeftion is removed, and hemorrhagy from that organ prevented. 7. In depleting the extremities of the veffels, and affording an opportunity to them of con- trading, it prevents hemorrhagy from the fto- mach and inteftines. 8. By creating an artificial weak part in the inteftines, theeffufion of lymph, ferum, &c. in vital parts is prevented. 9. By removing acrid matter immediately from affected parts, it takes off indirect debili- ty and ftrengthens the patient, f * In proof of this fpecific acVion I refer to its effects, in what has been improperly termed Idiopathic hepatitis. f For thefe effects of purging I refer to Sydenham; Hillary on the difeases of Earbadoes; Clark on difeafes in voyages to hot climates; And Dr. RuGVs account of th; effeds of purging in the Eillio-j; Yellow F«ver of—93. ( '9 ) II. It induces a counter ftimulus in every part of the vafcular fyftem, and by a determination to the throat and mouth faves vital parts. The cure of all fevers, confifts in exciting a new action in the veffels, or one, different from that which conftitutes the proximate of the difeafe* and accordingly no fooner do figns of the mer- curial action appear than all untoward fymptoms begin to decline. In its effects in dyfentery, Dr. Clark has made the following remarks, " For feveral years pall," fays he " when the " dyfentery has refuted the common modes of " practice, I have adminiftered mercury with " the greateji fucccfs, and am thoroughly per_ " fuaded, that it is pofleffed of powers to remove " inflammation and ulceration of the inteftines " in this diftemper."f Dr. Gilchrift, at a much earlier period, has noticed this falutary proper- ty of mercury in curing inflammations. " No- " thing embarraffes more" fays the Doctor, " than Inflammation in a low ftate j but, quick- " filver is a powerful antiphlcgiftic, and re- " moves inflammation without accelerating the * Hence the action of Peruvian Barkt and other comparative lo\0 ftimuii in curing flight cafes of Fevers, may be accounted for. •J- Clark on difcafes of voyages to hot climates. ( 20 ) " motion of the fluids, which it rather dimini- " fhes by fubduing their inflammatory difpofi- " tion, when there is little or no fever, it as " powerfully removes obftruction without de- " minifhing the impetus of the blood ; on a " proper degree of which refolution depends." I apprehend thefe effects in relieving inteftinat inflammation may be referred to a threefold operation. i- To its aclion immediately on the topical affection. 2. To its general operation on the blood-veffels. 3. To its operation in re- moving acrid matter from the parts affected by purging. i. In relieving topical affection. This may be underftood from its effects when topically applied to external ulcers, by which a fanious difcharge is, in a fhort time, changed for a lau- dable pus. Before I difmifs this fubject, I muft remark, that mercury appears to me to poffels exclufively the property of fuperfeding the ac- tion of all animal poifons, whether generated in the bodv by altered fecretions from its own organs, or derived from other animal matters externally applied :* this fuppofition derives * Dr. Ruth, in his account of the Yellow Fever of 1793, nas remarked, that fwellings of the Lymphatic Glands did :n no inftance fuppurate, where ( 21 ) fupport from its known effects, in the venereal difeafe, hydrophobia and fmall pox, which are all acknowledged to depend upon the fpecific ftimulus of animal poifon; perhaps, upon this principle, it will be found a fpecific againft the bites and flings of all venomous animals and infects. i. Its general operation on the blood-veffels* for this purpofe it muft be introduced into the circulation. This may be done by the feverai modes to be hereafter defcribed. Its action in this way is proved both from the change in the pulfe and in the fccretions fucceeding its ufe, for an account of which I refer to authors who have employed it in the cure of febrile com- plaints. 3. By removing acrimony immediately from the parts affected. This effect has been before noticed in this treatife, when treating of its effects as a purge, to which I now refer. The falutary effects of a fpontaneous faliva- tion, arifing in the malignant ftate of fever, f- mercurial falivation took place. Perhaps, this may be referred to this j-roperty of Mercury in counteracting or fupercedinjj the operation of th- -f-iifjn thrown on thefe glands. ( ^ ) have been noticed by many writers on pcftileu- tial difeafes.* But, thefe effects are much more confpicuous from a mercurial falivation. I will here enumerate the moft important. i. When copious, by abftracting ftimulu^ from the blood-veffels, it gradually reduce; the pulfc and obviates the further neceffity of purg- ing and bleeding. 2. By producing a new excitement, and a different determination to the fluids, it relieves the burning of the flomach and the diftrefting vomiting in thefe fevers. Large dofes are more gencially attended with this effect than fmall onen This appeared in a very linking manner in the cafe which I pubiifhed in October, 1797. The patient had been bled and purged freely, and was under the ufe cf mercury, in nearly ail the forms hereafter to be recommended, while the vomiting was fti-il diftrefting, with little or no mitigation of the other fymptoms, until by a mi (lake the nurfe gave at one dofe, a drachm of calomel which ha'l been left to be rubbed on the lips and gums, after which, her vo- * cy enham's account of the Continual Fever of 1C67—-5"; and 69.. Alto Huxham's Elf iy en Fevers. . ( *3 ) mitlng fuddenly ceafed, and the other bad fymp- toms declined until the fixth day, when a dif- charge from the falivary glands appeared, which was fucceded by convalescence.— Dr. Rufh, in his account of the ye'low fever, of this city in 1793, fays " the effects of mercu- " ry in every cafe where falivation was induced " were falutary." Dr. Wade, in his account of the fame difeafe in Bengal, gives the fame fa- vorable account of a mercurial falivation. Dr. Chilholm fays " that if a falivation (in the Boullam fever) was fpeedily raifed, the danger rras removed, and the patient recovered," and Mr. White, who practifed in the fame difeafe, declared, he did not Ioofe a fingle patient, where a quantity of mercury had been given fufHcient to excite falivation. I can alfo here add my own experience as a teftimony in favour of this evacuation. As in all the cafes I knew or heard of, where falivation took place in the Yel- low fever of 1797,1 knew of but one where the difeafe proved fatal. This patient periflied by a hemorrhagy from the gums on the tenth day cf the diforder, and after all other bad fymp- toms had ceafed. I impute this unfortunate event to his not lofing a fufficient quantity of ( c4 ) Hood early in the difeafe, as I did not fee him before the fifth day of his illnefs. The advan- tages of falivation in malignant fevers are fur- ther eftabliflied from its good effects in ihe plague at Algiers. One of the American cap- tives, who was ranforned at the time when a peace was concluded between the United States and the Dey, and now in this city, afterts that mercury was in general ufe in the cure of that diforder,that he had it himfelf, and was cured by a falivation, with the affiftance of fixteen bleed- ings. 'I here is alfo another advantage refulting from this action in the blood-veffels, as rclapfes never take place where the difcharge is fufficj- ently eftablifhed.* III. THE DIFFERENT MODES OF APPLYING IT, ANrjj •THE SEVERAL MEANS OF ASSISTING THE OPERATION, And i. By the mouth, 2. By the gums. 3. By frictions, * vid. Chifholm on the Malignant Feftilential Fever, &c« ( *5 ) 4. By fhoes or focks impregnated with the ointment. 5. By ointment in the form of Clyfters. 6". By fumigation, 1. By the mouth. Salivation may be induced by all the various and almoft innumerable pre- parations of this mineral which chemiftry pre- fents; but, as it is neceffary to keep up fome purging during the whole courfe of thefe fevers, for the reafor.s before mentioned, and as calo- mel cr the Iiydrargyrus muriatus mitis poffeffes a purging proper;y in an eminent degree over mod others, and fince it is one which has been molt employed, and more efpecially fince, from general ufe its virtues are better eftablifhed, I fhall prefer it to every other preparation for in- ternal ufe in this ftate of fever. In the firft days of thefe fevers, from the obfervations before made, ftrong purges are indifpenfable, and from their rapid progrefs and dangerous tendency there are to be fo employed as to produce as fpee- dy an operation as poflible. For this purpofe, ten or fifteen grains of Jallap are to be combi- ned with ten graitis of Calomel, and given eve- ry three hours until a difcharge is procured, an4 ( 26 ) as pills are known, fometimes to pafs through the whole tract of inteftines in an undiflolvcd flate, and from the obftinate obftruction which here attends, a large quantity of thefe purges may, probably, if given in the form of pills, be accumulatedina portion of the inteftines and be- come productive of inflammation and its confe- quences; they are always to be given in the form of powders. I know to thofe who are re- gulated more by the names of difeafes than their fymptoms, that fuch dofes may feem inadmiffi- blej but experience has'eftablifhed their fafety, and vv*e are here " to attend more to the effects produced than to the dofe.', * In many cafes five or fix of thefe dofes arc neceffary before the defired effect is produced. Mr. Wm. Bunting's apprentice boy, who was but eleven years old, in the yellow fever laft feafon, took two dofes of five grains of jallap, with the fame Quantity of calomel, each at the interval of two hours, and afterwards, four dofes of ten grains each, at the interval of three hours between, before any evacuation took place. To induce falivation, from three to five grains may be given every three hours, and cafes occur, where ten or even twenty grains may be given * Pringle's Difeafes of the Army. ( *7 ) at the fame intervals of time, not only with fafcty, but with advantage. Dr. Chifholm gave nineteen grains three times a day, and the pa- tient became convalefcent after the tenth day^ when he had taken 254 grains. I have even gone farther in its internal ufe with the greateft fuccefs. In one cafe, which I have before cited,the patient took three hundred and fifty fix grains in- ternally, in fix days, during which time, every other method of introducing Mercury into the fyftem was employed. At feeing this account let not the rigid dogmatift contract his brow into a frown of difapprobation ; but, rather let him learn, that where we would meet with fuc- cefs " we muft always accomodate the curative " force to the morbific or caufe of the difeafe."*" The form of powders is here alfo recommend- ed iri preference to pills or bolufes, both fo reafons before mentioned, and becaufc, in fwal- lowing them, part of the calomel adheres to the fauces and throat,by which means, the abforbing furface is increafed. If the calomel be tritu- rated with twice its quantity of loaf fugar, the patient, before an advanced ft age of the difeafe, ' can take it without any other addition ; but, in this cafe, from the drvnefs of the mouth, fauces * Brown's Element*. ( 28 ) and cefophagus and from the debility in the or- gans of deglutition, a fmall portion of f>me liquid muft be added to facilitate its paffage into the flomach. In this way a falivation is often excited in flight cafes, in the fpace of thirty fix hours; but, in cafes of more violence, a perfeverance for five and even ten days is often- er neceffary, and fometimes the irritabiltty of the inteftines is fo great as to render it impoflible to excite this difcharge by any internal prepara- tion whatever. When this happens, they are to be laid by, and recourfe is to be had to fome, ot all the means hereafter defcribed. 2. By the internal furface of the cheecks and lips and by the gums. Mr. Clare particularly recommends this mode of introducing mercury into the conftitution,* and Dr. Woodhoufe found it fpeedy and effectual in the Yellow Fe- ver of 1793. I fufpect it was effectual only when received into the circulation; and as it is probable falivation may be induced merely from the local and partial operation of mercury on the falivary glands without its producing any change of action in the general fyftem of * A New Method of introducing Mercury into the circulation, by P. Clare, Surgeon. ( 40 3 blood-veffels its ufe'is not to be relied on, with- out employing other means at the fame time.* To introduce mercury in this way, calomel is rubbed in on the gums, the infide of the lips and cheeks, or the mouth is wafhed with a fo- lution of corrolive fublimate in water feveral times in the day. 3. By mercurial frictions. The large num- ber of abforbents, fpread over almoft the whole furface of the body, and the effects fpeedily produced by mercurial frictions, eminently prove the facility with which mercury in this way enters theconftitutionand the determination which it difcovers to pafs off by the Salivary Glands, when thus introduced, renders it advi- fable to make an early trial of its efficacy in alt cafes of great danger. To produce a fpeedy aa effect as poflible, the whole body and extremities are rubbed twice or thrice, a day, with large quantities of the ftrongeft mercurial ointment ; * The late Dr. Wm. Annan, in his lad illnefi in the Yellow Fever of this city in 1797, exhibited a melancholy inftance of the local effects from this mode of applying Mercury. He had often during his illnefs, warned his mouth with a folution of Corrofive Sublimate, and when I faw him, two days before his death, and infilled on his ,ufing more Mercury internally, he urged as an objection, that his mouth was alrea-ty fufficiently afte&ed by the ufe of this gargle, ( 30 ) in more ordinary cafes, rubbing the upper and lower extremities, particularly in the courfe of 'he abforbents, with half an ounce of the fame ointment until it nearly difappears, twice a day will be generally fufHcient; before each inunc- tion, it is neceffary to wafli the parts to which it is applied in foap and warm water, as by that means the mouths of the abforbents, are freed from the oily matter left from the former appli- cations, cunremore immediately in contact with the frefh ointment. In thefe frictions, the nurfe or perfon who performs, fhouldtake the precau- tion of inclofing their hands in bladders, otherwife, from the great facility with which it enters healthy veffels, to what it does thofe under morbid excitement, fhe will be falivated before any effect is produced on the patient. 4. By impregnating fhoes or focks wifh mercurial ointment. This method, as far as I know, was firft introduced into practice by me in the laft fever that infefted this city, and not- withftanding it has been fuppofed, that mercury enters the abforbents with great difficulty when applied to the fkin without friction, experience has proved, that it is eafily taken up, when applied in this way to t;he feet. At the time ( 31 ) wjhen I firft began to ufe this mode, the neceffity of employing other means in the fame cafer, where thefe focks or fhoes were worn, rendered it impoffible to afcertain the time requi- red to affect the mouth by this way, but fince, I ltave falivated a venereal patient in four days time, by their ufe alone. In this mode, fhoes or focks prepared of bladders, are to be well lined with ftrong mercurial ointment, and confined on fhe patient's feet. 5. Mercury has alfo been employed, with fuppofed advantage, in this ftate of fever, by clyfters, prepared by adding the common ointment to ftarch or oatmeal gruel, thefe are to be frequently injected from time to time.* Probably Plenk's folution, would here anfwera better purpofe, as the mercury in this preparation, is lefs clogged, and from the abfence of oily matter would be lefs likely to be imme- diately returned, 6. By fumigations. This mode of affecting Xhe fyftem,.is remarkably fpeedy, in fo much that the mouth is fometimes affected in the fhort * This mode of introducing Mercury, was firft employed by my frienl pr. G,Gilleffie, onboard the frigate United Stiles, in 1797. ( 3- ) fpace of ten or twelve hours, but much danger has been apprehended from the application of thefe vapours to the lungs; this maybe prevented by confining them to particular parts and in dangerous cafes, we are by no means to loofe the probable advantages to be derived from To powerful a remedy, on account of fuch flender objections. It is applied by fprinkling cinnebar of mercury on coals contained in fome conve- nient vcffd fur the purpofe, which is to be held under the hams of the patient, while he lays on his back, the knees are in an inflected pofture, the bed-cloaths are to be well confined to prevent the efcape of the fumes, and their afieCling hi; lungs. From the aptitude of thefe fumes to affect the bowels with gripes and to pafs off by ilool, they ought always to be applied in a fmall quantity at a time, and frequently repeated, but they are immediately to be laid afide, as foon £3 the leaft affection of the bowels is threatened, In whatever way mercury is employed in the beginning of thefe fevers, and more efpecially* where much febrile heat prevails, its operation is particularly aftifted by blood-letting, and the application of cold water, rain cool air mid even :;ce to the fkin. ( 33 ) This practice has unfortunately been the fuL- ecl of much obloquy amongft the phyficians, who are rivetted to the dogmas of the former theory of the action of mercury, but as this theory is proved to be erroneous, and is now on the eve of everlafting oblivion, the fabric will ere long fhare the fame fate with its tottering foundation. So far are cold applications from injuring the conftitution, that their effects prove them always falutary, as thpy become an evacu- ant by abftracting heat, they relieve that intole- rable burning of the fldn, which is fo diftrefting in this ftage of fever, and fo far are they from militating againft the action of mercury, that they powerfully affift it, by leffening the prevailing febrile action. -Nor is this city the only pb.ce, where the falutary effects of thefe applications, have proved fo confpicuous as to warrant their propriety and general fafety. A Dr. Armftrong in the Weft-Indies, with a view of aflifting the operation of' Mercury, in the cure of malignant fevers, is faid to wafh his patients frequently in cold water with the greateft fuccefs. But in more advanced ftages of the difeafe, \vhere the fkin is cold, and the pulfe feeble or ( 34 ) imperceptible, every flimulating application to the furface, favours our views, for this purpofe are to be applied finapifms and blifters to the extremities; and cloths wrung out of hot brandy, faturated with fea fait, to be fucceflivcly laid over every part of the body, and renewed as often as they become cool. Hot bricks or jugs filled with hot water are alfo hpre applied with advan- tage. When we have "produced the defired effect from the ufe of one or all thefe modes combined, it fometimes happens, that the profufe difcharge from the falivary Glands, and the intolerable pains in the jaws and teeth, become objects of attention. WThen this occurs, two indications prefent. i. It is neceffary to mitigate pain. i. To moderate the difcharge and heal the local injury. The firft intention, as we are, from the nature of difeafe which preceded and from ap- prehenfions of relapfe, debarred from the inter- nal ufe of opium, is anfvvered by topical applications. For this purpofe opium is dif- folved in water and the mouth wafhed frequent- ly therewith, but I have lately found from ex- perience that milk anfwers the intention much L iticr than fimple water, my firft inducement ( 35 ) to ufe it was from its known properties of ob- tunding acrimony. My method is to triturate half a drachm of opium, in an ounce of pump water, and, when fufficiently diffolved, to add four ounces of new milk ; the mixture is then to be ufed as a gargle as often as the pains, &c. render it neceffary. The fecond indication is an- fwered, i. by determining the fluids to other parts, and, 2. by increafing the tone of thofe af- fected. The fluids arc called off hy purges OT laxatives, and blifters. Sulphur has been par- ticularly recommended by fome, not only as a laxative, but as it is known when combined with mercury to render it inert, it has been fuppofed to form fuch a combination in the fyftem and thereby to poffefs advantages peculiar to itfelf, while others have denied it to poffefs that pro- perty. Which of thefe opinions is moft correct, I will not here venture to decide; but as the flowers of fulphurprove an efficacious and conve- nient laxative, and as they are poffeffed of equal virtues (if we do not allow it any fuperiority) theyareftill preferred. As we are hereto keep up a gentleandregulardifchargefrom the inteftines, fmall and frequent dofes are recommended. When the fwelling of the falivary glands is great, C 3* ) blifters1 are to be applied, either immediately to the fwellings, or on the back of the neck. 2. The tone of the parts is increafed at the fame time by aftringent gargles, compofed of red rofe leaves, red oak bark or galls, with a fmall portion of alum and honey. Mr. Bell recommends a ftrong folution of Borax, as poffefled of peculiar vir- tues in anfweiing this intention ; but, from what trials I have made of this, I am inclined to think it inferior in efficacy jto feveral of the aftringents before mentioned. The introduction of Mercury into more gen- eral practice, has been retarded from a fuppofition of its injuring the teeth and conftitution ; but thefe effects are imaginary and without founda- tion; as, where the teeth have been found before its ufe, and the patient has been diligent in cleanfing the mouth, while under falivation, they have never been known in a fingle inftance, to fuftain any injury.* To refute the fuppofi- tion of injury done the conftitution, we need only refer to the conftitutions of thofe, who have recovered from malignant fevers by its ufe. Many have been cured of obftinate ulcers, fwel- * Vid. Rufli's works. ( 37 ) ling-? of the joints, Rheumatic pains and Chro- nic ohftructions of the vifcera, and moft enjoy better health than they ever had before its ufe. But, grant for a moment that the conftitution is injured, and the teeth deftroyed, from the ufe of this remedy. Is the lofs of a tooth or a trifl- ing injury to the conftitution to be put in com- petition with almoft certain death ? I fay almoft certain, as the chahce of recovery in Malignant fevers, without its ufe, is, at moft, aa one is to two. And I aril firmly perfuaded that, by its free and proper ufe, with the attention of nurfes, and a ftrict adherence to the antiphlogiftic regimen in the beginning of the difeafe, ninety niiie cafes of an hundred will terminate favourably. The belief, therefore, " that the yellow fever, plague, or other Malignant difeafes are neceflarily mor- tal, will be proved to be as much the effect of a fuperftitious torpor in the understanding, as the anc.ent belief that the Epilepfy was a fupernatu- ral difeafe, and that it was an offence againft: heaven to attempt to cure it."* * Dr. P..:h on the Bilous Vel'ow Fever, p. 318. FINIS. MeA.Hist. 171? o p , .• > >-. J'*.