1366. Modes Of Administration

1. Internally. The salt to be employed, and

* Clin. Lect., p. 157. On Stomach and Renal Diseases, 4th Ed., p. 63, et seq. Lib. of Med., vol. v. § Med. Gaz., April 6, 1S49.

|| On Diseases of the Urinary Organs, p. 108.

¶ Op. eit., p. 56.

** Lib. of Med., vol,iv. p. 292.

Diseases of the Abdominal Viscera.

the particular dose, must be regulated by the severity or character of the disease to be treated: - thus, in chronic or mild cases, the less active preparations of Mercury, as Hyd. c. Cret., Plummer's Pill, or small doses of Blue Pill, are indicated. Its alterative effect is also well obtained from minute doses of Corrosive Sublimate. In acute diseases, when its antiphlogistic powers are required, no salt is equal to Calomel, in doses of gr. j. - ij. every three or four hours, combining it with Opium, to prevent its passing off by the bowels. Some practitioners, with a view of speedily affecting the system, have advised Calomel in gr. xx. doses, repeated at long intervals; whilst others employ very minute doses, frequently repeated. Dr. Law,* of Dublin, states that gr. 1/12 of Calomel, repeated every hour, will produce salivation in from twenty-four to thirty-six hours, and the same effect may be produced by Blue Pill, in equally minute doses; the whole quantity required never exceeding six grains. Mr. Clay, of Manchester, advises this mode of administration; and in several instances, I have in this manner induced soreness of the mouth in Hindoos (Sepoys). I have never found more than two grains of Calomel, thus exhibited, requisite to establish soreness of the mouth, and mercurial fetor of breath. When it is desired to induce speedy salivation, Corrosive Sublimate is neither the most manageable nor the most certain preparation. Mr. Clay J states, that for a period of twenty years he has pushed it to a great extent, both in adults and in children, and that he has never been able to produce decided ptyalism by its use. According to the experience of Mr. Lempriere,§ however, it proves useful in the fevers of the West Indies. The Germans consider, that in order to produce speedy salivation, the Unguent. Hyd. Fort., given internally, is most efficacious. 2. Inunction. This is the most ancient mode of administering Mercury; and when it is desired speedily to affect the constitution, it may be advantageously combined with the internal use of the same remedy. Sir B. Brodie || (alluding to its use in Syphilis) considers that it is the most certain and preferable mode; that it is less apt to gripe and purge; and that it does not damage the constitution half as much as when taken by mouth. To be effectual, it should be rubbed in before the fire, for three-quarters of an hour at first, and afterwards for a shorter time. The great objection to it is its uncleanliness. Dr. West speaks highly of it in Pneumonia of children, when Mercury cannot be administered internally, 3. Fumigation. "This," observes Sir B. Brodie,¶ "is the least valuable mode of administering Mercury. You may affect the system too much or too little, and you may be taken by surprise by the patient's gums becoming all at once excessively sore." Notwithstanding the unfavourable opinion expressed by so high an authroity, fumigation with Mercury has been much employed, and with the best effects, by recent writers on Syphilis. Its value has been strongly advocated by Mr. Langston Parker, and the Calomel vapour bath is considered by Mr. Lee one of the best methods of bringing the system, in cases of constitutional Syphilis, under the influence of the metal. When it is desirable to employ fumigations, the patient should be placed in an apparatus like that used for Sulphur baths, and instead of Sulphur being thrown on a hot iron, the black Oxide of Mercury gr. lx., or the Sulphuret of Mercury gr. xxx., or Calomel gr. xx. - xxx., may be used. The patient may be very speedily affected, by allowing him to hold his head inside the bath for two or three minutes, so that he may inhale the mercurial vapour. Local mercurial fumigation is occasionally of great service.

13G7. Therapeutic Uses. Syphilis. For nearly three centuries, Mercury has been regarded as a remedy of first-rate importance, in the treatment of this disease; for a long period, indeed, it was considered by the highest authorities as a specific, and was con-

• Dublin Journ., Jan. 1839. Lancet, Aug. 21, 1841. Op. cit.

§ On Diseases of the Army in Jamaica (P).

|| Lectures, Lancet, 1844, p. 676. ¶ Op. cit., p. 677.

sequently employed indiscriminately, in every case which came under treatment. This injudicious practice was fully exposed by some of our military surgeons, including Hennen, Rose, Guthrie, &c, a few years since; and much has been written, both for and against the mercurial treatment of Syphilis. In France, for instance, M. Ricord has advocated the practice of giving a six months' course of a daily dose of Mercury, followed by a three months' course of Iodide of Potassium, in cases of indurated Chancre. On the other hand, so high an authority as Professor Syme states that the natural history of Syphilis, where treated by hygiene and external applications without Mercury, is that of a very slight disease; and the non-mercurial treatment has been recently strongly advocated by Dr. Hughes Bennett, Dr. Drysdale, * and others. Dr. Nevins,+ wilting in 1851, gave the following excellent summary of the facts disclosed by the controversy: -

1. That every form of venereal disease has been and may be cured, without the administration of Mercury.