–Pierce W.I.
MERCURIUS-QUICKSILVER-HG.
Introduction
Metallic mercury is silver-white in color and at ordinary temperature is liquid, hence its name, liquid silver, or on account of it mobility, or quick silver. Metallic mercury is occasionally found in nature, but it is obtained, for the most part, from Cinnabar, the red sulphide of mercury. This ore is heated and the mercurial vapors condensed by an elaborate series of cooling chambers. The metal mercury freezes at-40 degree F. or C.,and boils at 662 degree F., but volatilizes at all temperatures above 66 degree or 68 degree F., and it is due to this latter fact that we meet with so many cases of poisoning amongst miners, furnace-men or other workers in mercury, and that our records concerning its physiological action are so complete.
Symptoms
Mercury produces in general profound anaemia, with degeneration of the red-blood corpuscles, loss of albumin and fibrin and diminished coagulability of the blood; with this there is a marked tendency to destructive action, as seen in the inability of wounds to heal and in ulcerations of mucous surfaces and of the skin. Among the first observed effects of mercury is the increased secretion of saliva, which coexists with “fetor of the breath, swollen tongue, soreness of the teeth, a blue or dark slate- colored line along the margin of the gums with the teeth, soreness and sponginess of the gums, swelling of the parotid, sublingual and submaxillary glands, aching of the jaws and teeth, with general muscular soreness and some elevation of temperature. To this state are applied the terms acute mercurialismus ptyalism, or in common language, salivation ” (bartholow) ” and when this condition persists for a time, ulceration of the gums, mouth and teeth take place and inflammatory processes seize on the roots of the teeth. ” When patients were given large doses of mercury in former times, they were enjoined not to take water, since the chilling of the mouth and gums by cold water increased, in a very marked degree, the destructive action of mercury, so that, as this drug was used almost universally in the treatment of acute febrile disorders, the poor patients were not allowed the use of water” (Allen’s lecture). This will explain the statement we still meet with amongst our older patients, that water is not permitted in fever, even when there is thirst. “Throughout the whole digestive tract the mucous membrane becomes affected, from the action of mercury, with catarrhal inflammation; gastro-enteritis results, with inflammatory symptoms extending from the lips to the anus. Diarrhoea of course ensues, associated with colic and especially with tenesmus, and in older cases, haemorrhage. When the inflammation is violent and affects the lower portion of the intestinal tract, the symptoms are those of dysentery, the bloody stools being accompanied by a high degree of inflammations, secretion of mucus and with great straining. “The different preparations of mercury vary very much in intensity, and to some extent, in the character of the symptoms in inflammation of the gastro-intestinal mucous membrane. Calomel (Merc. dulcis) seems to act more upon the upper part of the intestinal tract, causing diarrhoea with much green mucus and with very little straining, while Corrosive sublimate (Merc. corr.) acts more upon the lower part of the intestinal tract, and the symptoms are more those of acute dysentery. ” Mercury produces inflammation of the liver and decreases the secretion of bile for this is certain, that after the first, the irritating effects of mercury, the bile becomes largely diminished and may even cease to be excreted, or at least to be poured into the intestine. The curative power of mercury over the liver which does not secrete the proper amount of bile, whether from intestinal inflammation or the occlusion of the common bile duct is undoubted. In both these cases mercury acts homoeopathically, and there is no doubt that its employment has been terribly abused” (Allen’s lecture). A thing for us to keep in mind is the fact as to its retention in the system. Dunham says: “Metallic mercury has been found in every tissue of the body of those who have taken it as a medicine. Once introduced into the system it remains. In this connection we must remember that when mercury has been taken so as to produce its constitutional effects, and these have entirely disappeared, the may long afterwards be re-excited by the action of medicines, which, becoming decomposed in the system, from soluble compounds with mercury. One of these is the Iodide of potassium.” On the kidneys “mercury produces a true parenchymatous inflammation. Frequently the interstitial tissue becomes involved, and chronic interstitial nephritis results. “One of the most common and characteristic effects of mercury, in a general way, is its ability to produce profuse perspirations. All the mercury patients perspire easily without provocation or on the slightest effort. Indeed, persistent dryness of the skin is sufficient to contra-indicate mercury. “On the tissues generally this powerful drug exerts the most destructive influence. It destroys the power of the system to repair lesions, so that cuts will not heal nor broken bones unite. In the bones it produces inflammation of the periosteum, which will lead on to destructive metamorphosis and death of the bone” (Allen’s lecture). “Instead of the ulcerations and inflammations.” says Allen, in the Handbook, “nervous phenomena sometimes occur, paralysis- agitans, epilepsy, melancholia and a remarkable chorea,” and “one of the most singular phenomena in the whole range of drug action is exhibited in the power of mercury to produce tremors. Its action on the nervous system is one of the curiosities of mercury. These tremors usually affect the muscles which are under the control of the will. These muscles respond to electrical action and are variously affected. The spasms are chorea-like in nature, and small objects held in the hand, for example, will be thrown violently across the room in the effort to carry anything to the mouth or to lay it upon the table. The muscles will not respond to the will. ” Sometimes the tremors are so violent that the patient cannot lie in bed, the jerks will throw them out of bed, or throw them when attempting to walk. With all these nervous disorders the patient has the most perfect consciousness. “Some of these tremors are wonderfully like paralysis- agitans, but yet they are different, at least I” (Allen) “have never been able to cure a case of paralysis-agitans by the use of any preparation of mercury, nor indeed do I remember ever succeeding with mercury in a case of chorea. These tremors are sui generis, and it is very doubtful if we meet with a similar condition in any natural disease” (Allen’s lecture). In the Handbook, Allen says, in reference to chorea, that mercury “may be indicated by the general cachexia of the patient rather than by the character of the spasms.” In mercury the long bones are attacked rather than the flat ones (the opposite of syphilis). The iris is never affected. Much that I have given you has been taken from a lecture by Dr. T. F. Allen, and published in the ” Chironian” for 1889. The following is also taken from the same sources and is well worth quoting in detail, as it treats of a more of less mooted subject. “I wish to call your attention,” says Allen, “to the remarkable fact, that among the thousands and thousands of persons who have worked in mines and factories, and have been poisoned by mercury, until their bones have decayed, no cases of syphilis is known, and these people are not at all particular about their associations, and are much more inclined to sexuality than others, because mercury positively excites the sexual desire. There people cohabit with the vilest of the vile, and the knowledge is widespread among them that they are proof against syphilis and prostitutes flock to the towns around the quicksilver mines and find profitable employment, who would not be tolerated in other mining regions,” and other miners are not especially squeamish either. ” If we examine into the matter we find the following interesting facts: that syphilis attacks different bones from mercury; that mercury attacks bones and joints that are rarely or never attacked by syphilis. Among a large number of workers suffering from caries, there was not a case of caries of the skull, tibia, clavicle of sternum, the bones which are particularly attacked by syphilis. ” Looking for a moment at syphilis, we find that one of the most characteristic symptoms, one that is most sure to occur, is iritis, and we find that among all the thousands of cases recorded of mercurial poisoning, there is not a case of iritis. Moreover, there has never been known an instance of ulcer of the glans penis among the cases of mercurial poisoning, nor has mercury ever produced any ulcer with indurated edges. Mercury does not produce an eruption like that of syphilis; it does not produce the hypochondria of syphilis; indeed, it may be said that among the provings and poisonings there is scarcely a symptom of syphilis. “How, then, are we to explain the destructive power of mercury over syphilis? We can explain it no more than we can explain the protective power of quinine over malaria. If, however, the patient be once attacked by syphilis, mercury will not antidote or remove it any more than quinine will remove marsh malaria, indeed, not as much. Mercury more thoroughly protects the system against syphilis and more completely fails to cure it than quinine in marsh malaria. “Some of the most pitiable cases seen in out hospitals are those who have first become afflicted with syphilis and then become saturated with mercury; the bones that syphilis did not destroy are destroyed by mercury, the tissues not affected by syphilis are affected by mercury, and his last end is worse than his former. “Speaking of iritis, I must say that I do not now remember a single case of iritis in all my experience presenting symptoms or being benefited by any preparation of mercury that did not contain iodine.” Merc. viv. is prepared for our use by trituration, at least up to the 3d. Hahnemann’s preparation of soluble mercury- Mercurius solubilis Hahnemanni-or Merc. sol., as it is usually called, is made by dissolving metallic mercury in nitric acrid and then precipitating it by caustic ammonia. It is probable that there is no essential difference in the effects of Merc. viv. and Merc. sol., and they are to be spoken of and used indiscriminately. The preparation Merc. viv. is to be preferred, as it requires less care and labor to make it, is more stable and perfectly pure; and as Hahnemann abandoned the use of Merc. sol., preferring in all cases to administer metallic mercury, or Merc, viv., it would be as well for us to do so. All the affections for which Merc. viv. is useful are worse at night and are accompanied by profuse secretions, especially of saliva and perspiration (185). The saliva is profuse (1630, distasteful and of bad odor, and the patients, instead of being relieved by perspiration, are, on the contrary, made worse by it (185). Mentally, there is weakness of memory (133), anxiety and depression of spirits, “a fear that they will not get well “(Allen’s lecture), or a feeling of apprehension, as if he had committed a crime (53), with general irritability, but Allen tells us to place but little weight on the symptom “hurried talking,” as found in heavy type in the Handbook, as it is seldom seen when Merc. viv. is the remedy. There is headache that is worse at night and with a sensation as it the brain were constricted by a band (105) or as if the head were in a vise. The scalp is tender to the touch (91) and the hair falls out, either as the results of the constrictive headaches, or “after seborrhoeic affections” (Dearborn). In the eye Merc. viv. is of value in many inflammatory conditions, with general aggravation at night and from firelight. In catarrhal and scrofulous ophthalmias (76) as well as in ophthalmia neonatorum we have muco-purulent discharges, which are excoriating, with soreness and burning of the lids. In ulceration of the cornea (77) we find a good deal of vascularity, the ulcers spread rapidly and there is danger of sloughing. There is pronounced aggravation from heat and from light, with especial intolerance of artificial light or the glare of the fire. This aggravation from firelight (74) has led to the successful use of the remedy in disease of the optic nerve and retina, especially when caused by working in the glare of a bright fire, as in foundry-men, puddlers, etc. In the ear, Merc. viv. is useful in inflammatory conditions, boils (640, suppurations and ulcerations, with severe pains, worse at night. The discharge is offensive (63), purulent and bloody, and excoriating; and excoriating discharges are found everywhere under this remedy. It is of value in acute and chronic catarrh of the middle ear, involving the Eustachian tube, with deafness 963), enlarged glands and may be sore throat, and it is of especial value for chronic catarrh of the ear and deafness following measles (63). In the nose we find the same tendency to ulceration an destructive inflammations, with soreness of the bones when touched (142. The odor from the nose is offensive and the discharge excoriating and Merc. viv. is of value in ozaena (148) with these symptoms. It is frequently indicated in acute fluent coryzas (37), with a thin, mucous flow that excoriates the nostrils (37) and perhaps with increased discharge at night. It is to be thought of for neuralgia of the face, the result of taking cold, with tearing pains, worse at night, and associated with salivation. As we have already said, the secretions are increased in Merc. viv., and especially noticeable is the increased of saliva (163) and it is a valuable remedy of the salivation of pregnancy (155), with soapy, slimy and stringy saliva. It aphthous stomatitis (140) we have superficial spreading ulcers and offensive ptyalism. It is a remedy useful for inflammation of the salivary glands, including the parotids, with swelling, soreness and perhaps suppuration, and very free secretions. The merc. viv. tongue is swollen, flabby or oedematous, and shows the imprint of the teeth as scallops along the edges (192). Besides its use in gastric, intestinal and hepatic conditions with the characteristic tongue, it has proved of value in glossitis, with severe pain and aggravation from any food or drink. The taste may be sweet, but it is usually metallic (186), coppery, or as if one had been holding a penny in the mouth. The gums are unhealthy, pale and spongy, bleeding easily from the slightest touch (84). The gums recede from the teeth (840 and there is an offensive odor from the mouth. It is of value for the condition of receding gums followed by decay of the teeth, which turn black (186), become loose (187) and fall out. The toothache is worse at night and from the warmth of the bed (187), with a tearing, pulsating pain. The teeth are sore to the touch and feel to long (187), and there is an increased flow of saliva. It is of value for dental periostitis, with formation of pus and soreness, looseness and elongation of the teeth. Abscesses at the roots of the teeth are often aborted by the use of this remedy (186). Various salts of mercury are of value in affections of the throat, each in its own sphere. Merc. viv. is useful in an ordinary catarrhal or inflammatory sore throat that grows worse towards evening; it is frequently given for follicular tonsillitis, but another preparation of mercury seems to work better than the metal in this condition, and the same is true in reference to diphtheria. Usually in Merc. viv. when ever there is any throat trouble, there is pain or sticking as from a splinter (190) on swallowing, and an inclination to swallow every time one’s attention is called to the subject to see if it still hurts. (A differentiation that is frequently noticed between this and other preparations of mercury is that in Merc. viv. the pain is not severe and on asking if it hurts of swallow, or which side of the throat is affected, the patient will swallow before answering; in the other salts that you might use, the aggravation is pronounced and no unnecessary experiment is resorted to.) In all the mercuries one cause for the frequent desire to swallow is the increased flow of saliva. The ulcers calling for Merc. viv., wherever found, are superficial, not deep,. and tend to spread rapidly. In the stomach and gastro-intestinal tract, external soreness (12) and inability to lie on the r. side are prominent symptoms. It is of value of enlarged and inflamed liver, acute or chronic, with jaundice (122), pain and soreness, aggravation at night and from lying on the r. side (8). It is useful for ascites (11) due to induration of the liver (127), for peritonitis and appendicitis. In catarrhal enteritis and other intestinal conditions of inflammation and ulceration, the stools nearly always contain mucus; they are green (59), scanty and excoriating, preceded perhaps by chilliness, and followed by burning at anus (61) and more or less tenesmus (61). With the diarrhoea we have in addition the nocturnal aggravation, the salivation and easy perspiration, and the flabby tongue. In dysentery it is indicated when there is slight fever but easy perspiration, and discharge of mucus and some blood; there may be prolapse of the rectum (160). The straining at stool in this remedy, the tenesmus,the never get-feeling is between that of Merc. dulc. which has little or none, and Merc. corr., where it is very severe. In the bladder Merc. viv. is of value for cystitis, with discharge of mucus. There is frequent desire and great urgency but little is passed, with burning during (196) and especially after urinating (197). It is also to be thought of in gonorrhoea, with greenish mucous discharge and burning worse “between the urinary acts” (Carleton). We have already spoken of mercury producing a parenchymatous nephritis, and it is of value in this condition (124), even when due to pregnancy, when in addition to albumin, blood and casts in the urine, w have nocturnal aggravation, the swollen, flabby tongue, and the profuse salivation and sweat, but, as Allen says, “for the love of your fellow man, do not hasten to give mercury because you have made a diagnosis of croupous nephritis” (lecture). The protest was undoubtedly made because Merc. viv. or Merc. corr. have been used so frequently as routine remedies in croupous or parenchymatous nephritis. Merc. viv, is of value in orchitis (188), the testicles swollen (188) and more or less hard, with paroxysmal pains worse at night and for threatened abscess, with sweat of the genitals. In the female, it is to be thought of for ulcers and abscesses of the vulva and for ovaritis, with suppuration, nightly aggravation and more or less tenesmus of rectum or bladder, or of both (22). Women who require Merc. viv. are prone to uterine haemorrhage and it is to be thought of for metrorrhagia in the aged (135). The breasts and nipples are swollen during menstruation (23) and it is said that instead of the menstrual flow we may have milk in the breasts. There is a greenish excoriating leucorrhoea (126) which causes itching, with burning after scratching (122), with increased flow at night (126) and after the menses. The cough of Merc. viv., which may be dry or loose, is always worse at night and form lying on the r. side (42). With these characteristics as a guide, Merc. viv. is to be thought of for chronic laryngitis and bronchitis, for pneumonia, usually of the r. side (151) and associated with hepatic disorders, and for chronic pleurisy, with sharp sticking pains in the chest (30) that are worse at night. In phthisis we would have a loose nocturnal cough and night- sweats (185), and in measles it is of frequents use with the excoriating coryza, the cough and the nightly aggravation. Merc. viv. is to be thought of in articular rheumatism, with pains worse at night and from the warmth of the bed (160); the joints are swollen and pale, and sore to the touch, and there is a profuse and offensive perspiration that affords no relief (161). On the skin it is of value for eruptions that are moist, bleed easily and tend to suppurate and ulcerate; it is of value of hasten suppuration (183) especially in glandular structures. The Merc. viv. patient is sensitive to cold air (5), yet perspires on the least exertion (185); the perspiration is profuse, offensive, sometimes oily, and is debilitating. If we ever give this remedy for intermittent fever, the one guiding symptoms would be that instead of feeling better when they begin to perspire, they feel wore during the sweating stage than at any other time of the paroxysm (121). Hep. s. lach. and Nit. ac. are antidotal; Silica is incompatible with Merc. viv. I use Merc. viv. 3d.