Ex Libris C. K. OGDEN THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES EXAMINATION OF THE PREJUDICES COMMONLY ENTERTAINED AGAINST MERCURY AS BENEFICIALLY APPLICABLE TO MOST HEPATIC COMPLAINTS, AND TO VARIOUS OTHER FORMS OF DISEASE, AS WELL A3 TO SYPHILIS. BY JAMES CURRY, M.D.F.A.S. &c. ONE OF THE PHYSICIANS TO GUY*S HOSPITAL, AND LECTURER ON THE THEORY AND PRACTICE OF MEDICINE. Audi alteram partem. LONDON: PRINTED BY J. M two treatises expressly bearing upon the general principle, which certainly stand in a different predicament, and entitle their respective authors to a fair share of credit, as careful observers of disease ; but for the reason assigned, I equally rejoice in their previous appearance, as being, in fact, so many progressive steps towards that more general doctrine which it is now my inten- tion to develope. In the first of these, (the observations of Dr. Hamilton on purgative me- dicines) the advantage of the practice is rested upon the ground of simple experience; and if it might not be deemed invidious, I think there would be no difficulty in shewing, that the re- spectable author is yet unacquainted with the true principle upon which his success depended. The second* stands in a much higher rank, as combining theory with practice. But Mr. * Surgical Observations. Part II. by John Abernethy, F.R.S. &c. &c. 8vo. 1806. Abernethy, with a candour which equals his acknowledged ability, not only attributes his first hint upon the subject, to his friend the late Mr. Boodle, of Ongar, in Essex, but, with corresponding liberality, states the mutual sur- prize which he and I felt, on discovering how great a coincidence of opinion existed between us, on a point hitherto so little adverted to ; mine arising out of my own feelings on a voyage to India more than twenty years ago, and gra- dually matured during the subsequent period in this country j his, though at first the suggestion of another, yet, confirmed and illustrated for the preceding seven years, by an extensive pub- lic and private practice in the metropolis ; mine in a great measure confined to the medical branch of the profession, his almost as exclu- sively to the surgical department. Yet it will soon be discovered, that although we nearly agree in the leading principle, we differ consi- derably in our application of it ; and that, what he refers to the chylopoeietic viscera in general, I look especially to the liver for. Let it not, however, be supposed, that I exclude the pow- erful influence of the stomach and intestines, as being often the chief source and focus of disorder which affects the system at large ; or mean to deny, that corresponding advantage will fre- quently arise from attention to these organs j on the contrary, it will be found, that it is what I 10 both inculcate and practise, as a part of my ge- neral plan. But what I venture to allege is, that in many instances, after we have done all we can in cleansing and strengthen ing the primae vise, we shall still fail of ultimate success, un- less we restore the hepatic function to a more healthy state ; and that by uniformly keeping this in view as a principle, and generally begin- ing with it in practice, we shall not only greatly abridge the time, and save both to ourselves and our patients, much of the trouble necessary to effect a cure, but shall be able to explain sa- tisfactorily to our own minds the immediate cause of relief, and (what is of no little conse- quence) often foretel to our patients, the vari- ations which they will experience during the progress of the treatment. * * Since these pages were written, another, and a still more considerable step has been made towards the complete esta- blishment of this ; I mean the valuable publication of Dr. Cheyne on Hydrocephalus. From the time I became a public teacher on the practice of medicine (now eight years), I have uniformly taught a doctrine with respect to this dis- ease, which, like some other of my opinions, has been gene- rally considered as wild and visionary ; it is, that acute hy- drocephalus is seldom if ever a primary and idiopathic dis- order of that organ in which its prominent symptoms and fatal consequences are so conspicuously displayed ; but that it is a secondary and symptomatic operation on the brain, arising from an inflammatory erethism or irritation of the liver, in consequence of that intimate sympathy which exists between With respect to the opinions which I enter- tain, and the practice which I recommend as the best I am acquainted with, like most others that have deviated from the hackneyed routine of the day, they have been at first ridiculed as absurd novelties, next abused as dangerous innovations, and lastly attempted to be followed ; because, on between these two viscera at all stages of life, but especially during the infantile and puerile periods ; and as a corollary from this, that, although at no time during the progress of the complaint are we to omit the use of means directed to the head itself, as a measure of security, yet that the most success- ful plan is, to take up the disorder in the early and probably the only curable stage, as hepatitis, and treat it by leeching and blistering the region of the liver, and by calomel given in such doses as first to excite the secretion, and next to emulge the ducts, of the liver. Although it be possible that the singular opinions of a London teacher may have found their way in the course of years to the Scottish metropolis, and a hint have been thus communicated to the acute and observant author in question, yet I am far from insinuating any thinglike plagiarism on his part. While I am willing to consider him, however, as perhaps equally entitled to the claim of entire originality in the doctrine, I beg leave to say, that my opinions, delivered in Lectures since 1800, and in a printed Syllabus in 1802, cannot possibly have been derived from Dr. Cheyne's treatise published in 1808 ; independent- ly of this consideration, that with me it is not a solitary and insulated sentiment, but makes a consistent and essential part of a general pathology. In the mean time, I most earnestly recommend an attentive perusal of his work, as one which, in my estimation, displays not less acuteness of remark, than soundness of judgment, and unwearied labour in observing disease. It a little farther examination, they were discovered to be not altogether absurd not always danger- ous and finally, because, when these rigorous censors had not only expenaed their stock of palliative means, but also nearly exhausted their patients' hope of any thing like a cure, they began to think with Celsus, that even a doubtful remedy (i. e. one, the mode of operation and the management of which they did not clearly un- derstand) was better than no remedy at all.* In saying this, however, I by no means wish to include all those who may have felt reluctant in yielding their assent. I make due allowance for the powerful effects of education and habit ; and still more for the dread which is very generally entertained with regard to the remedy especially requisite, from the effects occasionally observed to follow its mal-administration, in that disorder where it is the only specific that can be relied upon. Now, as persons of this cautious cha- racter, are those upon whom the general and successful application of any active remedy will for the most part depend, it is to their judgment and candour I would desire to appeal upon the question. For this purpose, I would begin by asking them how many instances have they met with, where Mercury has produced mis- chievous effects in venereal cases under their own ' Melius est anceps remedium quam nullum. CELSUS. 13 direction ? for I must exclude from our present consideration, its consequences when exhibited by quacks, or when taken by patients themselves without proper advice. I think I perceive a demur to this interrogatory ; and that each will alledge, though it has seldom or never occurred within his own practice, yet that it has happened to others. Let those again be asked the same question, and we shall have the same answer ; so that in the end, though all may affect to dread the remedy under others' hands, yet all con- tinue without hesitation to employ it under their own, because they find that nothing else will cure their patients. It is thus virtually admitted then, that it is not the remedy that does the mis- chief, but the mismanagement of it.* Now I * In the following passage this question is met fairly and answered explicitly. " As a particular objection to quick- silver, it has been repeatedly urged, that its use is highly injurious to the constitution. Although I have never met with any instance of the kind where the complaints could be fairly attributed to the remedy, yet I have no doubt but such cases do sometimes occur. I am persuaded, however, that the generality of instances adduced in support of this opinion, will be found to arise more from some fault of the constitution than from the effects of the medicine. In a number of vene- real cases, I have known the use of mercury carried to a most extravagant length, and the unfortunate patients suffer greatly for the time ; but I never found that one of them afterwards experienced any of these melancholy symptoms which are supposed to be induced by such treatment. The largest quantity 14 am very ready to go not only to the full ex- tent of this admission, but to grant still more, that like Antimony ,Opium, and every other active remedy, Mercury would probably do little good, if it were not also capable of doing some harm. The knife aud the caustic are unquestionably powerful, and in so far may be made dangerous instruments; but who ever blames the surgeon for employing a sharp knife or an active caustic, seeing that both the one and the other is to be directed by his eye, and guided by his hand; or who would be so absurd as to expect, that the quantity I ever heard of used by any person, was by a syphi- litic patient, who at last put himself under my care about four years since. The quantity of the stronger mercurial ointment he used in the space of two months was immense, besides calomel internally to a great amount. He was re- duced to the lowest state of debility and emaciation, and had eleven large spreading foul ulcers on his body. By the help of the nitric acid, and other medicines, he recovered in three months. Since then, he has continued free from any com- plaint, and is at present one of the most robust and healthy men I am acquainted with." See a paper in the Medical and Philosophical Journal, vol. 31. p. 109. Feb. 1809. Though the theory which the ingenious author adopts of mercury curing or suspending one disease BY inducing another is certainly erroneous as a general position, as I shall shew in its proper place, yet the cases he relates are not only valuable in themselves as facts, but are peculiarly so to me, as afford- ing incontestible evidence of the principles 1 have adopted j and I shall duly avail myself of their assistance hereafter. 15 couching needle and the gorget, which perform such wonders in the hands of an expert Oculist and dexterous Lithotomist, can be employed with equal safety or success, by every clumsy or in- experienced person who may fancy himself equal to the task of using them ? What these instru- ments are, then, with respect to the Surgeon, I contend and hope to prove, that Mercury is, under the management of a judicious Physi- cian, capable of doing, with (often indispen- sable) speed, and for the most part with perfect safety, what no other means hitherto known, can at all effect.* * Without accusing the male youth of the present day of greater laxity of morals than those of former generations, it may be asked, how many arrive at the adult age without having had occasion to use mercury ? Surely, then, if but few escape the necessity of using it, the destruction from this cause alone, should equal that from almost every other disease to which human life is subject. Let those who are inspired with such terrors respecting Mercury, look round, and candidly say how many such victims they have seen among their own acquaintances. That mercury cannot be borne by some constitutions, is incontestible : but what remedy is free from this objection ? Antimony often causes such prostra- tion of strength, as to require the utmost caution, or to preclude its use altogether; Opium, instead of inducing sleep, will in some occasion fainting, and in others frantic delirium ; but we never think of banishing those articles from general use, because they prove so unfriendly to individuals. The purposes of Antimony indeed, may frequently be answered by 16 I do not, however, mean to confine this de- cided superiority of mercury over other medi- cines, to that particular disease, in which the common experience of ages, and the express testimony of the ablest practitioners, unite in considering it as the only certain remedy; but would extend it to many forms of hepatic com- plaint, and to various disorders which arise in other parts as their consequences. By way of encouragement on this point, then, let us for a moment turn our eyes from the doubts and fears so commonly entertained about it here, and contemplate the very different light in which it is universally viewed in India, where the powers and effects of the remedy have been more fully tried than in any other part of the world. The inhabitants of that country, whether natives, settlers, or those who merely sojourn for a short by other remedies ; and the Hyoscyamus Extract will some- times fulfil the object for which we commonly employ Opium ; but for Mercury we have no such substitutes. Though I admit that there are constitutions to which perhaps Mercury can never be well accommodated, yet I think I have not only discovered the reason why, in many cases where it was administered under the direction of very able surgeons, its use was obliged to be given up whilst palpable proof of vene- real taint (such as nodes, &c.) still existed ; but that I can point out a principle hitherto overlooked, on which its em- ployment can be continued, so as not only to eradicate the Syphilis, but to improve the general health to a degree be- yond what the patient had enjoyed for some time before. 17 time, are so familiarized to its use, and so con- vinced of its superior efficacy in most of the dis- orders which prevail there, that they have less dread of mercury, than was once entertained even by the faculty in England, with regard to the Peruvian bark. Why is this ? It is, be- cause there are few intertropical complaints, in which the liver is not either primarily or second- arily a considerable partaker ; and in the suc- cessful treatment of which, therefore, the pre- vious removal of the hepatic derangement is not more or less necessary. Mercury, then, is the remedy which long continued and daily increas- ing experience has taught them to employ on such occasions j and, accordingly, mercury is held by them, nearly as indispensable to the cure of hepatic disorder and its numerous allied and dependant complaints, as it is with us to the cure of syphilis. But in reply to this it will most probably be said, that as liver complaints are comparatively rare in Great-Britain, why should we have so much recourse to mercury ? This is the very point on which I wish to join issue ; and I think I shall be able to prove (what daily observation is tending to confirm) that the liver is as often disordered in England as in India, though commonly not in the same mode, and certainly not in the same locally conspicuous degree ; and that, to the single circumstance of its being less obvious, is owing its having been so much overlooked ; as with us it far more fre- 18 quently consists in derangement of function, than in change of structure j and is oftener shewn in symptoms that affect remote parts, than in those which refer us directly to the liver itself as their seat.* There is still another view, however, in which this question respecting mercury ought to be con- sidered ; but which, as far as I know, has never * Ample proofs of this will be given in the course of the treatise intended to follow. But until these can be brought forward, it may not be amiss to offer an example of the po- sition, which will not only claim attention from the celebrity of the person in whom it occurred, but may induce many who now think otherwise, to admit, that intemperance of any kind is not necessary to the production of liver disease ; and consequently, that it may exist in numberless instances where its presence is never once suspected. " For a very long period, Sir Joshua Reynolds enjoyed an- uninterrupted state of good health, to which his custom of painting standing may be supposed in some degree to have contributed ; at least by this means he escaped those dis- orders which are incident to a sedentary life. He was indeed, in the year 1782, distressed for a short time by a slight para- lytic affection ; which however, made so little impression upon him, that in a few weeks he was perfectly restored, and never afterwards suffered any inconvenience from the malady. But in July 1789, he for the first time perceived his sight so much affected, that he found it difficult to proceed ; and in a few months afterwards, in spite of the aid of the most skilful oculists, he was entirely deprived of the sight of his left eye. After some struggles lest his remaining eye should also be affected, 19 been adverted to by any one. It stands acknow- ledged by the latest and best writers on syphilis, that whatever be the essential nature of its pecu- affected, he determined to paint no more. Still, however, he retained his usual spirits, was amused by reading, or hear- ing others read to him, and partook of the society of his friends with the same pleasure as formerly ; but in Oct. 1791, having strong apprehensions that a tumour, (afterwards found to depend on extravasated blood unconnected with the optic nerve) accompanied with an inflammation, which took place over the eye that had perished, might affect the other also, he became somewhat dejected. Meanwhile he laboured under a much more dangerous disease, which deprived him both of his wonted spirits and his appetite, though he was wholly unable to explain to his physicians the nature or seat of his disorder. During this period of great affliction to all his friends, his malady was by many believed to be imaginary ; and it was conceived that if he would but exert himself, he could shake it off". This instance, however, may serve to shew, that tlic patient best knows what he suffers, and that few long complain of bodily ailments without an adequate cause ; for at length (and not till about a fortnight before his death) the seat of his disorder was found to be in his LIVER, of which the inordinate growth, as it aftei'wards appeared, had incommoded all the functions of life ; and of this disease, which he bore with the greatest forti- tude and patience, he died after a confinement of near three months, at his house in Liecester-square, Feb. 23, 1792." " On his body being opened, the liver, which ought to have weighed about five pounds, was found to have increased to an extraordinary size, weighing: nearly eleven pounds. It was also somewhat scirrhous." Malone's Life of Sir Joshua Reynolds, prefixed to his works. I trust 20 liar poison, there is no person, however healthy, that is absolutely proof against its infectious influence ; or in whom, when the contamination has once decidedly taken place, the powers of the constitution are adequate to its radical cure,* unless assisted by medicine, and especially by its great antidote, mercury. Now it is a notorious fact, that if to a person who is otherwise in the most perfect health, we give mercury for the cure of a small and recent venereal ulcer, and carry it (as is generally required) so far as to I trust it will not be considered disrespectful to the cha- racter of the two eminent physicians who attended Sir Joshua (both of them dead several years) to say, that upon the prin- ciples of pathology which I adopt, and the mode of searching after the source of disease which I mean to recommend, the primary cause of his disorder would have been ascertained, early enough to point out clearly the employment of such means as might perhaps have superseded all the symptoms that took place subsequent to the slight paralytic affection in 1782. * I have heard it advanced on high authority, that genuine chancres will sometimes heal of themselves. Now although I doubt the position, I cannot absolutely contradict it ; but admitting it to be true, I would ask whether in such cases, the constitution remains free from taint, and whether, al- though the ulcer has not so much of the venereal disposition as to prevent its healing like simple ulcer by common means, a portion of the poison has riot entered the system, and will not display itself in the secondary form, of ulcers in the throat, &c. at some future period, so as to require the use of mercury for its removal ? affect the mouth, we shall seldom fail to find, that, frequently, as soon as it has got to this point, and very generally when it has been con- tinued for a little longer, the appetite diminishes, and a degree of languor and weakness is felt over every part of the body.* As the medicine is left off, however, these inconveniences gradually subside j and the patient, if he does not incauti- ously expose himself to cold (to the impressions from which he is for the time rendered much more sensible), will find not only the ulcer cured, but his appetite and strength restored as per- fectly as before. Here it will not be denied, that the sensible effects of the medicine, inde- pendently of its curing the ulcer, are in them- selves morbid ; and in such instances the utmost we can say for it is, that while we thus induce one morbid state, which is limited both in its degree and continuance, we eradicate another, the duration and mischief of which are known to terminate only with life. But, is this exactly the case in hepatic disorders ? I do not hesitate to affirm, that it is not ; and that, on the con- trary, in very many instances of hepatic de- rangement, where the symptoms were so promi- nently displayed in the digestive process, as to make the complaint be referred to the stomach alone as its source ; mercury under proper ma- * The reason of this will perhaps appear, when we come to investigate the mode in which mercury acts upon the human system. C nagement, so far from lessening the already impaired appetite, or exhausing the diminished strength, has increased the former to a degree which was even distressing to the patients, from the mouth being so tender as to prevent their in- dulging in solid food to the extent they craved for, and has so much improved the latter, as to enable them to go through their ordinary business with greater ease and alacrity, than they had done for many months before ;--and these desir- able changes, so far from being merely tempo- rary, have continued.* Surely, then, it will * Three years ago, a gentleman put himself under my care on account of a herpetic eruption affecting small patches of skin on different parts of the body, attended with heat and itching, and latterly with a disappearance of the hairs from the parts affected. He had been subject to this com- plaint for several years, and it was usually treated by local applications, which removed the heat and itching, but left behind a shining redness, especially on the face, which has continued more or less ever since. His general health was always affected at those times, but of this no notice was taken by his medical advisers. Several years ago, while at Oxford, a superficial inflammation and abrasion took place sponta- neously on the glans penis; and the surgeon there to whom he applied, taking it up at once as syphilitic, put him im- mediately upon a course of mercury j under which not only the local complaint gave way, but his general health was so much improved, that when he returned to town, he received the congratulations of his friends, upon his having acquired flesh, and looking better than he had done for several years. His London medical friend, however, who had certainly a very 23 not be asserted, after the multiplied evidence which I can produce of this fact, that the two cases are exactly parallel ; and that mercury is very extensive opportunity of seeing such complaints, was convinced by the account he gave, that there was nothing syphilitic in its nature, and blamed the Oxford practitioner for having used mercury unnecessarily. The truth, however, is, that both were right, and both wrong ; for the one gave a remedy which he intended should cure a venereal taint that really did not exist, and by so doing he removed a state of constitutional disease which he neither understood nor suspected, and of which the local affection in this instance was merely an effect ; the other would have treated the local affection entirely by topical means, and probably have suc- ceeded in healing it, but he would thereby have left the con- stitution still labouring under the previous morbid tendency, and ready to display this in some palpable form, either in the same or in some other part, accordingly as co-operat- ing circumstances might determine it. The result of this case amply confirmed the truth of what I here advance. As be- sides the cutaneous affection, he complained of general irk- some sensations, which he could describe no otherwise than by saying he was not well, I was led to inquire particularly into the state of his alimentary canal. I found that although his appetite was not deficient as to the quantity of food, yet that he neither ate with the same relish, nor experienced the same refreshment from what he took, as he had formerly done ; and that notwithstanding his bowels were evacuated everyday spontaneously, yet that the faeces were evidently unhealthy, being generally of a clayey appearance, and when thin, very like yeast. His urine likewise was usually pale. These cir- cumstances left no doubt in my mind, either as to the source of his complaints, or to the plan I ought to pursue to restore the free excretory office of the liver, which was evidently sus- c 2 pended. 24 as injurious to the constitution in hepatic as it is in mere syphilitic complaint ! Yet it is almost entirely from the inconveniences which are ob- served occasionally to follow its administration in SYPHILIS, and this administration in many in- stances acknowledged to be ill conducted, that the general dread of the article has arisen ; for pended. Accordingly, after two or three unsuccessful at- tempts to bring bile speedily into the intestines, by giving at bed time a few grains of Calomel, joined with an opiate, and with a small proportion of Tartarized Antimony, and followed by some Colocynth Extract on the succeeding morning, I found it necessary to proceed more slowly, and endeavour to rouse the liver, and free its ducts from obstruc- tion, by the use of the Pilula Hydrargyri. For several days no sensible change took place, but at the end of that time, he became suddenly affected with nausea, followed by retching, during which he threw up some bile from the stomach, and soon after passed a considerable quantity down- wards, mixed with a matter very much resembling minute portions of curd, or as if the patient had been eating nuts, which had passed through undigested. To allay the sickness, a saline effervescing draught was ordered ; and this was the only medicine he required afterwards ; as the nausea quickly subsided, his bowels became regular, and the foeces duly tinged with bile, at the same time that his appetite and sleep were perfectly restored. During the progress of his indisposition, and until the obstruction was removed, the hair had continued to fall off, not only from a great part of the scalp, but had begun to do so from his chin, and from his legs; and the bald- ness was at last so conspicuous, as to require the use of a wig. But in a short time, as his strength improved, the hair re- turned to the denuded parts ; and his general health has since continued with fewer interruptions than he had experienced for many years before. as hepatic disorder is commonly believed to be rare in this country, a fortiori, the use of this remedy with a view to remove such disorder, cannot be very frequent, and (of course) its evil or good under such use, cannot be fairly appreciated. Such are the arguments which may be of- fered, to rebut those heavy and indiscriminate charges so commonly brought against the use of mercury in general ; and, in my opinion, they are quite sufficient for the purpose. Let us now carry the investigation a little farther, and inquire whether these arguments may not be greatly strengthened, by equally valid evidence, shewing the unexpected collateral benefit obtained from it, in many cases where it is expressly given to extinguish syphilis. It has repeatedly happened, that persons who had been long complaining of general indisposition, marked by symptoms so vague in their character as to be often referred to a distempered fancy, have, unluckily as they at first thought, but fortunately as it turned out, became the sub- jects of venereal infection ; but, not less to their own agreeable surprize, than to that of their medical attendants, have had all the symptoms they preyiouly complained of, completely re- moved, by the remedy which was given merely with a view to cure the syphilis, and which was probably the very last that would otherwise have been resorted to. Now, as many of their 26 most distressing sensations had existed long be- fore they had become the subjects of syphilitic infection, it surely will not be alledged, that the first in order of time were an imaginary antici- pation of, or in any way connected with, those of later and purely accidental occurrence. But if they were not, how are we to explain the great relief obtained under the administration of a remedy which, it is allowed on all hands, never improves a constitution already healthy? It is, by removing a state of disease, which the faculty and the public have alike agreed to ac- knowledge their ignorance of, by embracing its numerous and Proteiform shapes, under the equal- ly comprehensive and vague term of Nervous. That the human frame is liable to various forms of disorder, to discriminate which individual terms are still wanting, will readily be granted. But admitting this, are we never to attempt an investigation of them on some general principle, whereon we can systematically and satisfactorily proceed in their treatment ? and, whilst we are inveighing against quacks and quackery, are we tacitly to acknowledge ourselves the former, and either daily practise the latter, or candidly tell our patients that they may do this, or that, or the other thing; or, as some do (who most probably are strangers to indispo- sition themselves,) bid them be content under their sufferings, and do nothing at all ? Our pride and self-love ought to forbid the one, and 27 our acquaintance with what has already been effected by medicine, should stimulate us to rescue the profession from being reproached with the other. Who would have believed only one hundred years ago, that the same power which amused children by attracting straws to- wards a piece of amber when warmed by fric- tion, or sparkling on the hair of a cat's back when rubbed in the dark, should afterwards be completely identified with that tremendous agent which sets the atmosphere in a blaze, shivers the tallest masts, and demolishes the strongest ramparts; and that farther discoveries should have taught us to protect ourselves against its violence, by conducting it silent and harmless to the earth, through a piece of wire, or even along a wetted pack-thread ? Or who could have anticipated, even at the period of the latter discovery by Dr. Franklin, thatthe same influence which thus operates so destructively in the thunder-storm, should be found nearly allied to that principle which resides in the brain and nerves of all living animals, to be necessary to their functions, and to be usefully super- added or abstracted by art, for the removal of certain diseases to which these organs are liable ? Again, can we doubt that the man who first cut into the human bladder to extract a stone, or who plunged a needle into the eye to displace by force a part of that delicate organ, must have been considered as a rash and dan- gerous experimenter ? even though it was done, in the one case to prevent a lifetime of pain, and in the other, to remedy the privation of sight ; both of which, but for these innovations ! would have still remained incurable. Yet do we now see these operations performed daily, with the utmost safety, and the happiest success. Surely then, if such invaluable improvements have re- sulted from combining accurate observation with cautious experiment, there is no occasion to abandon as hopeless, and still less right to censure as absurd, any premeditated attempt at carrying the science and the practice of medi- cine to a higher pitch than they have yet at- tained. It is with the hope, and in the belief, that I can add something to the present stock of knowledge in both departments, that I shall undertake the task of publishing; and that those who hear of what I teach, and what I practise, only through the tortuous channels of ignorance and of prejudice, may be able to de- cide for themselves, and bring the question to final issue, under their own impartial trial and adjudication. Happily for the cause of truth, the claims of this doctrine to notice, do not rest upon my authority merely; for I shall hereafter shew, that most of the same facts and observations with those upon which I have grounded it, are to be found scattered through the writings of the 29 ablest physicians, from the earliest ages down to the present day. I can assume no superi- ority then, in merely seeing what others had seen, or in noting what they likewise had recorded ; for it required only the same watch- fulness to observe, and the same fidelity to de- scribe. But what I think I may claim some merit for, is, the bringing together those detached facts originally collected by myself, and uniting them into a chain of evidence, so as to render them mutually illustrative of each other, and give strength and uniformity to the whole. Neither does the evental fate of the principal remedy at all effect the stability of the principles upon which it stands recommended to our at- tention; for experience teaches us, that the same indication of cure can often be fulfilled by several different means, though certainly not by all in an equal degree ; and in the course of the work intended to follow this, it will be seen, that although certain forms of hepatic obstruction may be removed by merely lessening general plethora or local congestion of blood, and others by repeated gentle purgatives, such as Chelten- ham water, &c. either alone, or aided by warm bathing, and diaphoretics, yet that there are other forms, wherein their employment can be of little avail, unless aided by mercury, or by some other equally powerful remedy, with which we are yet to be made acquainted. I should, so therefore, deeply lament the hasty rejection of this invaluable article; because I believe, that, if impartially estimated, it will be found to be, like small-pox inoculation, though occasion- ally productive of inconvenience, yet the pre- ventive of infinitely greater mischief from the spontaneous course of the disease which it is in- tended to mitigate 5 and that until Providence shall vouchsafe to make some fortunate indi- vidual the rival of a JENNER in fame, by disco- vering to him (if any such exist) a perfectly harmless antidote to syphilis, and an equally efficacious remedy in hepatic complaint, we ought still to employ, with proper caution, the best in either view that we at present possess, viz. MERCURY. On a subject of such importance, and where the current of popular prejudice runs so strong, it becomes a duty to oppose this by all the ar- gument in our power ; and as the authority of an individual, who is perhaps little known, and certainly much misunderstood, if not pur- posely misrepresented, cannot be supposed adequate to the task, let us hear the sen- timents of one whose ability is acknowledged, and whose long and extensive experience has given him perhaps unrivalled opportunities of forming a correct judgment -, merely premising, that what HE so forcibly and elegantly says with respect to the use of mecury in syphilis, I 31 hold to be, with few exceptions, applicable to its employments in liver complaints. " Men (says he) may amuse thamselves by declaiming against mercury, as an uncertain re- medy ; they may utter querulous details of its baneful effects, and retail tragical stories of its malignant influence on the bodies and minds of those who use it; but surely all this turbulent eloquence may be directed with equal advan- tage, not only against every potent article of the materia medica, but against the very aliment by which we are sustained. " Almost every department of physical science contains propositions which require exceptions, or against which objections may be brought that scarcely admit of a satisfactory solution. Yet, notwithstanding these, philosophers do not suppose it necessary to abandon duly veri- fied axioms, because a few phenomena not perfectly understood, seem to militate against them. "He who shall discard all general rules be- cause they admit exceptions, ought likewise for the sake of consistency to renounce all science, because human knowledge is fallacious and im- perfect. " My opportunities of administering mercury have not extended to less than twenty thousand cases; and I feel myself authorized to assert, that it is a remedy always to be confided in, under every form of lues venerea; and where we have only that one disease to contend with, that it is a certain antidote, and as safe in its operation, as any other active medicine drawn from the vegetable or the mineral kingdom. Let me not be misunderstood here, as if I meant to say, that it is a certain and safe remedy in the hands of any one who undertakes to dis- pense it. Quite the contrary ; for a multitude of indisputable proofs might be adduced, that ignorance and error often render it one of the most precarious and mischievous medicines in use/'* As I expect it will here be objected to me, that I have strained the testimony given in favour of mercury in a disease where it is indis- pensable, in order to apply it to cases which can be cured with equal certainty and greater safety by other remedies, I have particular pleasure in quoting in favour of this article as a general remedy, the opinion of a gentleman, whose views of disease are marked by so much * Observations on the various articles of the Materia Medica, in the cure of Lues Venerea; illustrated by cases, (2nd. ed.) By JOHN PEARSON, Surgeon to the Lock Hospital ; fyc. 33 soundness of reasoning, and supported by such a strength of facts, as entitle him to the very universal respect and attention which his publi- cation has excited. " We are often told of the pernicious effects of mercury on the constitution ; but if I were to judge from my own experience, I would form an opposite conclusion. In ' cases where mercury was carried to such a length, that the patients have been for two weeks without tasting almost either meat or drink, the cure was most compleat. In some instances this was done where the pa- tients were supposed to have suffered greatly from previous salivation ; and so far from injur- ing the constitution, the process appeared to give it new energy, and the most perfect health has been the consequence."* Unfortunately it is not the case with the practice of medicine, as it is with several other branches of science, that a proposed improve- ment of it can be rendered so immediately de- monstrable, as to supersede all farther objection - f on the contrary, a full proof of the superiority of any one plan of cure over others, can only be * Cases of Diabetes, Consumption, fyc. with observations on the History and Treatment of Diseases in generaL By ROBERT WATT. 1808. 34 obtained by an extended consideration of nu- merous facts and observations, and by a general conclusion drawn from thence, which at once fully accords with the phenomena, and is per- fectly consistent with itself. The history of medicine, and the fluctuations it has undergone in the progress of ages, will sufficiently evince the truth of this ; nor has any general doctrine, or individual remedy, however superior it has ultimately been found to those before in use, ever made its way to an immediate and general adoption among contemporary practitioners. Antimony was once expressly prohibited in France, by the recommendation of the faculty of medicine at Paris. The Peruvian Bark, which has held so eminent a place in the materia medica for the last 130 years, and even been looked on by a late physician of high repute as almost an universal remedy,* met with violent opposition on the continent till recommended by the Pope's physician, amj[ was at first dis- countenanced in this country by Sydenham ; nor, though strongly advocated by his contempora- ries, Dr. Prujean, President of the London College of Physicians, and by Dr. Brady, Pro- fessor of Physic at Cambridge, did its use be- * Dr. Heberden in his Comment, de Morbis. 35 come general in the cure of intermitting fevers, until its superior success under the management of Dr. Talbor, overcame all further opposition. With regard to mercury, it will have still greater obstacles to encounter in the public opinion, from its being so long and so intimately associated with an opprobrious complaint; and we must expect, that there will still be found many, who are so much under the dominion of prejudice, and so little influenced by reason, as to reject every evidence in its favour. The history of variolous, and still later of vaccine inoculation aifords melancholy analogous proofs of this, which the memory of every expe- rienced practitioner will readily supply to him. I have twice in my life been told by patients, who were snatched from the brink of the grave by the aid of mercury the one under obstructed liver, attended with dropsy, which threatened speedy suffocation, the other under a very sin- gular and distressing complication of disorders which have resisted all the various means em- ployed for several years that they would nev^er have taken the remedy, had they known what it was; although neither of them experienced much inconvenience from, its use:* and a gen- * It may be proper to add, that the first patient probably paid the forfeit of her life as a tribute to her obstinacy; as I understood, that about a year after I left the part of the country tleman lately assured me, that he lost the bu- siness of a family by proposing, and that fa- mily has since lost their child by rejecting, the employment of mercury externally in hydro- cephalus, although by means of this medicine given internally, an elder child had before re- covered from an almost hopeless stage of the same disease. With such persons, argument and reason will seldom avail much ; but they ought still to be urged by us as a part of our duty ; and if obliged to retire from the contest without effect, we can only say, should they have decided for themselves " quos Deus vult perdere prius dementat." Having now offered such preliminary remarks as appeared to me necessary and proper on the occasion, I would address a few words to my professional brethren ; upon whose decision the immediate fate of any new proposal must in a great measure depend. To their judgment and country where I then resided, she had a return of the ob- struction, accompanied with dropsy, which proved fatal. The other made the amende honorable most completely ; for the remedy having be ; .ig suspended only at her own desire, the symptoms recurred again, and she ivas easily persuaded to resume its use, ^ ; h amply rewarded her by removing the complaint entire^ , and with even less inconvenience than before. 37 candour I shall willingly submit it ; neither con- temptuously challenging their hostile opposition, nor meanly soliciting their partial favour. What- ever may be our difference of opinion at present, still the question is not a personal one between them and me; but one in the just determination of which we are equally interested. To all libe- ral criticism, from whatever quarter it may come, I shall respectfully attend ; and will readily ac- knowledge any correction which it offers; for on such a question, I consider an author as stand- ing \nforo conscientite ; and, where the issue may involve the future comfort, if not the existence, of thousands, I hold, with the amiable Bonnet, that u one candid acknowledgment of error, is of more real value than a hundred ingenious replies."* * " Unfai tort vaut mieux que cent repliques ingenieuses" J. M'Croery, Printer, Black-Horse-Court, Fleet-Street, London. . UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. REC'D COL Ufc MAR 14 1989 tu fifii DC 3 Form L9-Series 4939 1158 00647 4224 001385970 r RM 666