In Diseases of the Spinal Column, where there is extreme pain and tenderness over a portion of the spine, which has not existed for any length of time, and where symptoms clearly indicate the existence of chronic inflammation of the bones, or incipient ulceration of the inter-vertebral cartilages, Mercury may be employed with a very good prospect of success. It acts by preventing the effusion of lymph, which, pressing on the nerves as they emerge from their canals, produces either partial or total paralysis. (Mr. H. Smith.)
Hamilton, who advised Mercury to be given until the gums were sore, having previously employed venisection. A modification of this treatment was successfully and extensively adopted by the late Dr. Hope.§ If the patient was strong and plethoric, he was bled at the outset of the attack. Calomel gr. viij., with Opium gr. iss. at bedtime, was followed in the morning by a purgative draught of Infus. SennAe. During the day, the following draught was administered: - Vin. Colchici exv., Pulv. Ipecac. Co. gr. v., Mist. Salin. 3x., M. ft. haust. ter in die sumend. When the pain and swelling were greatly reduced, which occurred generally in two, and almost always in four days, the Calomel was omitted, or, if the gums became in the slightest degree tender, it was discontinued earlier, but the Opium and the other remedies were continued. By these means, a cure was generally effected in seven days. No local treatment, excepting fomentations, was employed. The advantages of this plan, according to Dr. Hope, are, the great rapidity of cure, the relative rarity of cardiac inflammations, and, when these do occur, their easy resolution, compared with that which follows other modes of treatment. Dr. J. Johnson* considers that Mercury is, perhaps, of all remedies, the most powerfully anti-rheumatic; hut Dr. Macleod regards it as more adapted to the fibrous or diffuse form of Rheumatism than to the synovial form; in which, he observes, it often fails. Dr. J. Bird thinks, that it is more useful when given in doses to produce a cathartic, rather than a constitutional effect. In Acute Rheumatism in plethoric subjects, both in England and India, he regards it as an invaluable remedy, from the special action it exercises on the biliary secretion, and as an agent for depurating the blood. In Rheumatism occurring in Sepoys, Dr. Malcolmson§ regards Mercury as beyond measure the best of all remedies; he adds, "There are very few forms in which that disease is seen in India, in which it is not safe, and generally effectual." It may be observed, however, that authorities are by no means unanimous as to the value of Mercury in Acute Rheumatism. By those who advocate its use, it is not given in the same heroic doses as formerly. It is doubtful whether it possesses any peculiar power of lessening the duration of the disease. In Chronic Rheumatism, the mercurial treatment is inferior in efficacy to many others, unless it be of a syphilitic origin, when a mild course of Mercury has been found to afford benefit.
* American Journ. of Med. Sciences, Aug. 1833. Med. Times, op. cit., p. 215.
Medical Commentaries, 1783. § On Diseases of the Heart, p. 179, Ed. 3.
1422. In Sciatica and Lumbago, a mild mercurial course has occasionally proved effectual, when other remedies fail. In acute cases, Prof. Graves|| states that there is no one remedy in which he has greater confidence than the following, which he has repeatedly seen productive of striking benefit: - Morph. Acet. gr. iij., Calomel, gr. vj., Pulv. Jacobi gr. xij., M. ft. pulv. vj., sumat. j. tertia hora. It must generally be continued until the gums are slightly sore. In less acute cases, where the patient has to be much exposed, or to follow his avocations, the Iodide of Potassium is to be preferred.
1423. In Acute Synovitis, the same treatment as in acute inflammation should be pursued; local or general depletion, followed by Calomel and Opium, until the gums are slightly sore. Cold lotions, or warm fomentations, according to the sensations of the patient; perfect rest and antiphlogistic diet, are the other measures from which benefit is obtained. If the inflammation arises in gouty or rheumatic subjects, Colchicum may be added or substituted; if in subjects debilitated by Syphilis, or by a previous course of Mercury, Iodide of Potassium.
* Medico-Chir. Rev., vol. lvi. p.540. On Rheumatism, &c., 1842, Lond. London Journ. of Med., March 1851.
§ On Beriberi and Rheumatism, p. 27, part ii.
|| Dublin Journ., vol xviii. p. 244.
1424. In Scrofulous Affections of the Joints, and in Morbus Coxarius, Mercury, so given as to induce speedy but slight ptyalism, has been advised by Drs. O'Beirne, Bellinghara, Graves, &c, but the practice has never been adopted generally, in consequence of the well-known injurious influence of Mercury in other scrofulous affections. Its advocates, however, speak highly of its efficacy, and enjoin at the same time perfect rest.
1425. In ununited Fractures, a mild mercurial course, so as gently to touch the gums, will occasionally be found to accelerate a cure. A case strikingly illustrative of this is related by Mr. B. Cooper.*
1426. In Phlegmasia Dolens, leeches should in most cases be first employed, and after their application, should the urgency of the symptoms not be subdued, Calomel in small doses, with or without Opium, will, in the majority of instances, be attended with great benefit. (Churchill.) Inunction with mercurial ointment (Ung. Hyd. Fort. ij., Ext. BelladonnAe 3ij.) is recommended by Prof. Graves.:}:
1427. In active intractable HAemorrhage, Mercury, carried to slight salivation, has been highly spoken of. Dr. Latham mentions a case of Epistaxis, which resisted all ordinary remedies, but yielded immediately the mouth became sore. Dr. Southcy also states that he has been taught by experience to rely upon Mercury almost as a specific for obstinate hAemorrhage, whether attended by inflammation or not. Dr. Watson§ adds, " Whatever may be the modus operandi of that mineral, the fact is certain, that haemorrhage, which has resisted all other modes of treatment, has, in very numerous instances, ceased at once, upon the occurrence of a moderate degree of salivation."