1381. In Puerperal Fever, Puerperal Peritonitis, Calomel Has Found Its Advocates

Dr. Churchill* observes that, after full depletion, the next most powerful remedy is Calomel alone, or in combination with Opium. It may be given in large doses, or in small ones frequently repeated, and it should be continued until an impression is made upon the disease, or until the mouth is affected, unless purging be induced, in which case the Calomel may be omitted, and the Opium continued alone. After a decided effect is produced, the dose may be diminished, and the intervals lengthened. Dr. R. Lee substitutes Dover's Powder for the crude Opium. Dr. Locock, without denying the value of Calomel in some instances, remarks that he has seen patients recover where the mouth has not been affected, and several die where full mercurialization had been established. The testimony of Drs. Ferguson and Collins, also, is not in favour of the mercurial treatment. It is often extremely difficult to establish salivation in these cases.

1382. Diseases Of The Heart

In Carditis, Pericarditis, and Endocarditis, active treatment is necessary, or, in some cases, the disease will run to a fatal termination. Immediately after depletion, local or general, Calomel may be had recourse to. It should be given in doses of gr. j. - iij. with gr. j. - iss. of Opium every four or six hours, and Ung. Hydrarg. may be rubbed in at the same time; the object being to induce speedy salivation. Dr. Hope§; observes, that " a manifest abatement of the symptoms generally takes place, immediately on the effect of the remedy becoming apparent in the mouth, especially if a free salivation be established within the first thirty or forty hours." The same views and mode of treatment are advocated by Dr. Latham,|| who gives the annexed table, showing, that where salivation has been readily induced, the exocardial murmur of Pericarditis has, at an early period, disappeared.

Case

Salivation produced in 1 day; the murmur ceased in 4 days.

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* Practice of Midwifery, p. 470. Lib. of Pract. Med., vol. i. p. 359. See Murphy, Lect. on Parturition and Lactation, p. 594.

§ On Diseases of the Heart, p. 187. || Lectures on Diseases of the Heart, p. 208.

Dr. Taylor's* careful observations render it probable that the value of Mercury in these cases has been overrated, and that more benefit was derived from the blood-letting, which formed a prominent feature in the "heroic" treatment, than from the Calomel. The question of the exact value of Mercury in fheumatic Peri- and Endocarditis cannot at present be considered definitely settled. There is no doubt that formerly mischief was not un-frequently done by the enormous doses of Calomel prescribed in these affections. On the other hand, the balance of evidence up to the present time is decidedly in favour of mild mercurializa-tion. Antimonials may be joined with the mercurial treatment, antiphlogistic regimen enforced, and a slight soreness of the gums should be kept up for a week or ten days, unless the symptoms yield in that period.

1383. In Hypertrophy of the Heart, the long-continued and frequent employment of Mercury in small doses has met with a strong advocate in Mr. Salter; and Dr. Colles, likewise, has dwelt with much emphasis on the beneficial influence of this remedy over some of the most distressing effects of ''Morbus Cordis"." (Dr. Joy.)

1384. In Arteritis, when Mercury is not contra-indicated by a strumous or shattered constitution, Dr. Hope advises its use in such doses as to produce slight but prompt salivation. It should not be employed until the first violence of the inflammation has subsided, when its use is attended with excellent effect.