Eng., Ointment of Mercuric Nitrate. Synonym, Citrine Ointment.

The official Tablets of Corrosive Mercuric Chloride, commonly called Bichloride Tablets or Antiseptic Tablets, are extensively used.

They contain about 7.3 grains of the mercuric salt with some agent or agents to facilitate solubility. They may be white or contain coloring matter. It is desirable to use those of odd shape and color, and in a distinctive style of package, so as to avoid error. They should not be prescribed for patients' use, except in original packages (if at all). These should not be confused with the"Alkaline Antiseptic Tablets,"used in making mild sprays and gargles.

Therapeutic Action

The salts and preparations of mercury are generally alterative, antisyphilitic and germicide. Mass of Mercury, Mercury with Chalk, and the Mild Chloride are particularly purgative. The Ointment of the Nitrate, the Red Iodide and some others are active irritants.

Uses

The employment of the salts and preparations of mercury covers almost the entire realm of medicinal treatment. They are particularly used for syphilis in all of its forms and stages; as purgatives in the early stages of acute diseases, such as intestinal indigestion, typhoid fever, pneumonia, etc.; for parasitic diseases, ulcers, impetigo, etc. Extensively employed as wet or dry antiseptic dressings, etc.

Toxicology (Mercurialism-Hydrargyrism)

Mercury poisoning may be acute, subacute, or chronic. A common form of acute poisoning is that occasioned by taking an excess of some poisonous mercuric salt, usually the corrosive mercuric chloride tablets. This is frequently done with suicidal intent or by error, as mistaking them for headache tablets. The patient may have intense pain, particularly in the epigastric region, and usually purging, tenesmus and bloody stools. Nausea and vomiting may or may not occur. The treatment is to wash out the stomach, preferably with water containing milk or the white of eggs, and, when this has been done, to leave a large excess of the albuminous matter in the stomach. Morphine may be used for the abdominal symptoms, and the patient otherwise treated symptomatically.

A subacute mercurialism may develop from one or a few doses of a mercurial given as a purgative or in an effort to rapidly produce results,. as in the treatment of syphilis. It should be emphasized that"salivation"from a simple calomel purge is now extremely rare. Like human hydrophobia, it is often heard of, but seldom observed. Its rarity may, in part, be due to the quality of the drug as now marketed. The usual toxic symptoms are fetid breath, disagreeable taste, swollen gums and a profuse flow of saliva. There may be lesions on the gums or elsewhere and the teeth become loose or even fall out. There may be abdominal pain, purging and bloody stools. The treatment is to discontinue the mercury, give opiates and demulcents if necessary for the intestinal symptoms, and use mouth-washes for the local lesions. Probably the best mouthwash is one containing potassium chlorate, tincture of myrrh and tincture of belladonna leaves. Belladonna internally is frequently used to advantage. Potassium iodide used with proper care has been recommended.

A purely chronic mercurialism may develop from the continued use of the drug or in those whose work exposes them to it. The symptoms resemble those just described, but it is more apt to be characterized by necrosis of bone and cachexia.

Administration

Care should be exercised that irritating or poisonous compounds are not formed. Particular consideration should be given when the patient is taking iodides, and in making local applications of mercuric salts they should not come in contact with iodine. Some of the common uses and methods of employment are indicated in the following:

By Mouth

As a purgative the Mild Mercurous Chloride, Mercury with Chalk and sometimes Mass of Mercury are the preparations used. For children, the first two are employed, usually combined with sugar of milk and administered in powders. For adults, the Mild Mercurous Chloride is the preparation of choice, though the others are used. It may be administered with sugar or sugar of milk, in powder or capsules. A more common method is a combination with some other purgatives put into capsules. Among the other agents used are such as Phenolphthalein, Podophyllin, Compound Extract of Colocynth, Rhubarb, Inspissated Oxgall, etc. Strychnine and sometimes Atropine are also used. Extract of Hyoscyamus and Powder of Ipecac and Opium are. very often associated in these mixtures to prevent griping.

Some combinations are shown in the following:

As an initial purge in the treatment of grip, etc.; also in alcoholism:

M. ft. cap. no. ij. Sig.-One every hour.

As a purgative:

M. ft. cap. no. iij. Sig.-One every hour.

Or:

M. ft. cap. no iij.

Sig

Take an hour apart.

As a laxative in tuberculosis:

M. ft. cap. no. xxiv. Sig.-One at night.

As a purgative (for child 2 years old):

M. ft. cht. no. v.

Sig

One every half-hour.

When nausea and vomiting are factors this is often put into ten powders and one given every fifteen minutes.

1 Musser and Kelly: Practical Treatment.

In the treatment of acid intoxication of infancy:

M. ft. cht. no. xx.

Sig

One every three hours till relieved.

As an alterative, antisyphilitic, etc., the preparations most commonly used are the Yellow Mercuric Iodide, the Red Mercuric Iodide, the Corrosive Mercuric Chloride, and the Mild Mercurous Chloride. The Red Mercuric Iodide and the Corrosive Mercuric Chloride are more frequently prescribed in solution with potassium iodide when the soluble Potassio-mercuric Iodide is formed.