Mercurius syllables. [2(NH2Hg2) NO3H2O]. Solution. Mercurius vivus. (Hg.) Trituration.
MERCURIUS SOLUBILIS was a preparation made by hahnemann in order to be able to administer mercury in a milder from then the corrosive salts of mercury in use in his day. It is prepared by precipitating mercury from its solution in nitric acid by means of caustic ammonia and is not pure mercury.
Mercurius vivus is a trituration of pure mercury with sugar of milk. Both are in common use and their actions are indistinguishable.
All forms of mercury, including its numerous salts, induce the same general effects on the system, but the soluble salts acts more quickly and acutely than the insoluble, as they are more easily absorbed.
Mercury salts are absorbed from the alimentary canal and from inunction into the skin. When injected hypodermically, or into the muscles in an insoluble form, they are taken up by the leucocytes and distributed over the body. The pure metal itself when finely divided may be oxidized and absorbed, as when it is given triturated with chalk as grey powder, rubbed into the skin as ointment, or inhaled into the lungs as vapour, in all of which ways of entry it produces its constitutional effects. It is precipitated from its salts when it comes in contact with protein and is taken up by the leucocytes in this insoluble form. What further happens to it before it is excreted is not well known. After prolonged use it is found in almost every organ of the body but chiefly in the liver, kidneys and intestinal wall. It is eliminated by almost all the excretory glands and appears in small quantities in the perspiration, milk,saliva, gastric juice and bile, but is most largely excreted by the intestines and kidneys. It passes to the foetus in utero through the placental circulation. Excretion by the kidney begins soon after its administration is commenced, but it very slow, and mercury may still be found in the urine months and even years after it has ceased to be taken. In acute poisoning, as when a soluble salt like the perchloride has been swallowed, there is at once a harsh metallic taste followed by burning pain in the mouth, throat and stomach. Nausea and vomiting of fluid and blood with shreds of mucous membrane ensue. On this soon supervenes diarrhoea with violent tenesmus and bloody stools and there is accompanying collapse, a small, thready, irregular pulse, rapid respiration, cold, clammy skin, pinched features and sunken eyes. The temperature is subnormal, the consciousness unaffected. Urine is diminished and contains albumin, or it is suppressed. Death may occur from shock within an hour, but the patient usually survives a week or so and then sinks from exhaustion. If he lives a few days salivation and stomatitis occur.
Digestive Tract.-In chronic poisoning the effects are not due to the local irritant action of the drug but to its influence after absorption,and it is the symptoms so caused that determine the place of mercurius in medicine. The most of these are observable in the mouth and throat. They are metallic taste, numbness of the tongue and soreness of the gums, then the parts become swollen and covered with superficial ulceration with a dark bluish-grey coating; a very foul odour form the mouth is perceived and there is an excessive flow of an irritating saliva that excoriates the lips and the skin over which it flows. Salivation is not a reflex irritation from the stomatitis, for it may precede it. The gums round carious teeth are the first and most severely affected, indeed the presence of teeth seems to be indispensable for the production of stomatitis, the initiation of which is a lesion of the alveolar periosteum. The teeth ache, become loose and fall out. Salivation is profuse, sometimes excessive and may amount to several liters a day. Ulceration appears on the cheeks, palate and tonsils, the throat feels sore and dry and there is great thirst. The pain in the mouth and throat is stinging and burning. The swollen tongue and inflamed condition of the mouth and throat render the taking and swallowing of food difficult or impossible and also cause impediment to speaking. The parotids and submaxillary glands are swollen but not inflamed. The odour from the mouth is sui generis and becomes almost insupportable. Haemorrhages occur from the gums and ulcers and the condition of the mouth may go on to gangrene. There may be caries of the jawbone; this is not a primary action of mercury on the bone but is an extension of the involvement of the gums from the alveolar periosteum. mercury is excreted in the saliva and by the glands of the mouth and throat, and it is to this that salivation is due.
The stomach symptoms are less severe; there are loss of appetite, and weight and discomfort at the stomach with tenderness on pressure of the epigastrium, nausea and vomiting of food, mucus and bile. The liver is swollen and tender. Rumbling in the bowels, with colic and pains in the abdominal muscles come on and are associated with diarrhoea of mucous, bilious, blood- stained stools, often containing fragments of mucous membrane. They are frequent, not very copious, and attended with tormina and tenesmus. The patient feels chilly while at stool and the tenesmus is long continues, he feels “he cannot get done.” Mercury is excreted in large amount by the intestines and causes very distinct lesions in the caecum and colon. Inflammation progressing to necrosis and ulceration occurs along the folds of the large intestine and may end in perforation. The small intestine escapes.
Urine.- There is frequent urging to pass water but the urine is scanty and contains a small amount of albumin. In mild cases the urine may be copious. At post mortem in cases where there has been suppression of urine the kidneys have been found hyperaemic. the glomeruli acutely inflamed, and necrosis of the epithelium of the tubules, which were filled with a deposit of phosphate of calcium, has been observed. Itching of the fossa navicularis and smarting in that situation during the passage of urine take place. Catarrh of the urethra with a greenish-yellow discharge is present.
Sexual.-Mercurius causes ulceration of the glans penis and inflammation of the glans and prepuce. The inflammation of the prepuce may lead to a condition of phimosis with retention of secretions which further aggravates the balanitis. Irritation of these parts causes children to scratch and pull at the genitals, especially at night. Lascivious excitement and painful nightly erections occur with emissions. There is increased sweat and genitals and between the scrotum and thighs. The testicles are swollen, hard and shining.
The menses are usually scanty and irregular and they may be suppressed; the flow is pale and offensive. Abortion and premature births are caused by chronic mercurial poisoning.
Skin.- On the skin mercury causes, when locally applied, small reddish spots, large patches of erythema, urticaria or eczema, followed by desquamation, but these affections occur also from internal administration, especially the skin eruption known as eczema mercurial. This consists of innumerable minute, pellucid vesicles which make the skin appear red and feel rough, they may be accompanied with fever; the serum of the vesicles becomes opaque and and milky. The rash soon extends over the whole body and is associated with swelling, itching and tenderness of the skin. A copious discharge may take place from the surface. This rash terminates with desquamation. Sometimes the hair and nails fall off and the eyebrows and eyelashes are denuded. Occasionally a severe from has been observed in which the vesicles become bullae, the eruption dark red and purple, an odour arises from it like stale fish, and serious general symptoms, such as chills amounting to rigors, prostration, sleeplessness, delirium and even coma occur. Inflammation of glands, abscesses, boils and gangrenous ulceration may ensue. Petechiae sometimes appear on the abdomen and lower extremities and widespread serpiginous ulcers may appear. Itching and burning are usual concomitants of mercurial skin affections.’
Nervous System.- Some of the most striking symptoms observed in chronic mercurial poisoning are those relating to the nervous system. They have been collected mainly from workmen engaged in work involving the use of mercury, such as mirror and barometer makers. A mercurial erethism is produces, the patient becomes abnormally irritable and sensitive; though not usually shy he feels confused on being looked at, every trifle makes him excited and hurried, he is ill-humoured and easily angered and he has rapid transitions from passionate outbursts to pusillanimity. Memory and judgment are weakened, there are melancholy and great depression, he weeps and laments, screams with terror, and tires to get out of bed and flee away. Sleeplessness, terrifying short dreams an hallucinations may occur and the patient may talk of committing suicide. These nervous symptoms are more or less prominent with the one great characteristic nervous phenomenon of mercurius, namely, the tremors. They occur first in the hands and arms, then in the legs, and sometimes they extend to the muscles of the neck and trunk. They affect principally those muscles which in health are most subject to the will. The will loses power over the muscles, co-ordination is impaired, the patient cannot grasp small objects but he can generally lift heavy ones. In the first degree the tremors are small in compass, like those of paralysis agitans, but they afterwards become more convulsive and then approach to the movements of chorea ; the head, arms and hands are in incessant motion of unequal and spasmodic character, the speech is broken and indistinct from spasm of the diaphragm and trembling of the tongue, the patient falls if he attempts to walk and there may be vertigo. Attacks tremor may be induced when he is quiet, from a cold draught blowing on him, from any emotional excitement or unexpected incident, such as some one coming suddenly into the room. The spasms are always clonic, never tonic in character. Additional nervous symptoms caused by mercury are shooting pains along the nerves and in the joints, circumscribed areas of partial anaesthesia, amblyopia, anosmia and deafness, localized paralyses of the muscles of the arms or legs may occur, but there is no wasting of muscles, as is the case with lead paralysis. Delirium and transitory hallucinations are sometimes observed, but in poisoning by mercury the mind is usually remarkably clear. The tremor and general muscles weakness are probably of central origin; at one of the autopsies on a fatal case, a bloody covering, a third of an inch thick, was found over both hemispheres extending as far back as the tentorium. The paralyses sometimes observed are believed to be caused by the poison acting on the peripheral nerves and destroying the myelin sheath.
Blood.-The condition of the blood is altered by mercury, which renders it more fluid, the fibrin, albumin and red corpuscles are diminished, and it coagulates with difficulty and forms a very soft colt. There results a cachexia and general anasarcous state of the body, with palpitation, panting respiration and general prostration. large doses of mercury lead to an increase in the number and size of the vessels to the bone- marrow, the fat cells atrophy; later, gelatinous degeneration follows and the cellular elements of the marrow disappear.
Sleep.- The sleep is disturbed and the patient wakes in fright from terrifying dreams.
Fever, &c.- Probably mercury has no action on the temperature centres themselves but the temperature is frequently raised in association with, and secondarily to, the inflammations caused by it. This is often of a hectic character, accompanied by profuse perspirations, especially at night, which do not relieve the general symptoms, and there are frequently recurring shudderings and a sensation of coldness throughout the body.
The chief employment of mercurius in material doses has been in the treatment of syphilis. It is given in order to destroy the organism, the spirochete pallida, that is the cause of the disease, and the dose aimed at is one just short of that which will produce symptoms of mercurial poisoning. Arsenic in one or other of its preparations is usually given concurrently or in alternation with it. It is most valuable in primary and secondary syphilis and less efficacious in the tertiary stage. Administration is by mouth, inunction or intra-muscular injection. The last method is the one usually preferred, but it has the disadvantage of causing considerable pain and swelling in the tissues which are the seat of injection. It is commonly given in syphilitic iritis in conjunction with the instillation of atropine into the conjunctival sac to dilate the pupil. In the forms of calomel and blue pill it is much used as a purgative in “biliousness” and cardiac dropsy.
Externally it is employed as a disinfectant wash in surgical operations in the form of solutions of the perchloride or cyanide; caution must be used, as many cases of acute mercurial poisoning have occurred from its absorption, notably when used as a vaginal douche after parturition. In the from of ointment mercurial salts are in favour for skin disease, especially those of parasitic origin, and for the skin affections and ulceration s of syphilis. Citrine ointment (ung. hydrarg. nit.) has been much used in conjunctivitis; it is acid and irritant, and had better be used in the form of ung. hydrarg. nit. dil., which is citrine ointment diluted to one in five.
In the smaller doses employed homoeopathically mercurius is one of the most widely used remedies. its profound influence on the blood, on the mucous membranes, skin, glands, and secretory organs gives it an extensive range and makes it applicable to a multitude of diseases.
Syphilis.- Its power to cause inflammatory affections and ulcerations of the skin and mucous membranes, as well as pains in the bones, especially the long bones, that are worse at night, makes it a very suitable remedy for venereal sores and the ulcers and skin eruptions of secondary syphilis. It is, therefore, even in infinitesimal doses, a remedy for syphilis, but only for the lesions of syphilis to which its action is similar. It would not in these doses be fatal to the spirochaetes, at any rate not directly fatal, and one would not in so serious a disease forego the benefit that can be gained from the administration of preparations of mercury and arsenic given in doses lethal to these organisms.
Digestive Tract.- Mercurius is indicated in stomatitis and simple aphthous inflammation of the mouth, with foul odour of the breath, salivation, and sharp, stinging pains that are worse at night ; the tongue is swollen, covered with thick, yellow, moist fur, and has the edges indented by the teeth ; in gingivitis and toothache from carious teeth, when the gums are spongy and receding, the teeth tender at the roots, so that they feel too long, the pain is worse at night, from the warmth of the bed, and from taking anything cold into the mouth ; the crowns of the teeth decay, the roots remain ; in sore throat, when the throat feels dry although the mouth is full of saliva and the tonsils are swollen or suppurating, with sharp sticking pains on swallowing (hep., nit. ac.).
The action of mercurius on the salivary glands makes it useful in mumps, and its power to inflame lymphatic glands gives it a place beside belladonna, which it will usually follow, in inflammations and suppurations of those organs.
Though the action of mercurius on the stomach is not very marked, it is useful for various disorders of digestion. There are violent thirst, although the mouth and tongue are moist; aversion from meat, wine, brandy, beer, coffee, greasy food and butter; excessive hunger or complete anorexia, or appetite only for bread and butter; the pit of the stomach burns, and is swollen, and is sensitive to touch. Catarrhal gastritis is the complaint for which it is generally given, and it is useful also for the sudden vomiting of milk in infants.
Mercurius causes swelling and tenderness of the liver, and is a remedy for jaundice consequent on obstruction of the common bile-duct from inflammation secondary to gastro-duodenal catarrh. The patient cannot lie on the right side.
On the small intestine mercurius has little or no influence, but its ability to inflame and ulcerate the large bowel gives it a prominent place in the treatment of diarrhoea and dysentery; there are colic, constant urging to stool, tenesmus with chilliness, the passage of stools that are usually small in amount, green or of green mucus (arg.nit., bell., ipec., sulph.), bloody, acrid, which excoriate the anus, and the passage of which does not relieve the tenesmus.
Head.- The headaches calling for mercurius are generally associated with disorder of the stomach or liver, and are full and bursting, or there is a feeling of constriction as of a band round the head compressing it; the pain in worse from a draught and in the open air and better in a cool room. The whole scalp is painful to touch; the hair falls out; there may be a foetid, oily sweat on the head, or offensive, moist eczema.
Eyes.- Mercurius inflames the conjunctiva as if does other mucous membranes, and is very useful in blepharitis, keratitis and episcleritis when the discharges are profuse, burning, thin and acrid, and are worse at night from warmth, especially the heat of a fire or lamp. It is, therefore, much used in the eye affections of workers in foundries. The eyelids are swollen and inverted, lachrymation is profuse and excoriation, and the lids are spasmodically closed. The higher potencies have been recommended for iritis, syphilitic or not.
Ears.- Mercurius is an important remedy for inflammations of the external and internal ear with much sanious, offensive discharges; also for deafness due to catarrh of the eustachian tubes.
Nose.- It is a favourite medicine for nasal catarrhs in which there is much sneezing and the discharge is fluent, corrosive and offensive, and excoriates the upper lip. The nose is red and swollen, and the nasal bones are painful to touch. Nose bleeding during sleep is an indication for it.
Sexual.-Mercurius has been much used for ulcerations on the genitals of both men and women, for catarrhal and gonorrhoeal discharges,-for pruritus pudendi, balanitis, and swelling and suppuration of the inguinal glands (buboes).
Respiratory.-It has but a limited sphere in respiratory diseases, but is serviceable for hoarseness, bronchial catarrhs and bronchitis when there is a short, dry, fatiguing cough occurring chiefly at night, when the patient is warm in bed, and which may be accompanied by stitching pains through the chest walls from front to back on sneezing or coughing. The chest feels dry. The cough is worse from lying on the right side, from change of weather and from night air. Mercurius affects the lower lobe of the right lung (chel., kali c.).
Skin.-Besides the skin eruptions occurring in the secondary stage of syphilis, eczema rubrum, when it is of the same description as eczema mercuriale, calls for mercurius, and it is also indicated in boils and ulcerations of the skin that have a lardaceous base, a tendency to spread and to undermine the edges and to the formation of foul-smelling acrid pus.
IN the affections for which mercurius should be prescribed we should bear in mind its deteriorating influence on the blood, which causes discharges easily to assume an offensive, sanious character, which leads to a general anaemia or cachexia to muscular relaxation and prostration, to emaciation and to general nervous and mental weakness. . . . In the last condition the tremors set up remind one of those of paralysis agitans and it should be thought of in that disease. It has been used in meningitis. For periostitis, especially of the tibia, when the pain is worse at night and from the warmth of the bed, it is one of the chief remedies, and it should also be considered in the more advanced caries of bone, such as caries of the spine or of the bones of the face and skull, when there is much low-grade suppuration.
(1) Cachexia, anaemia, exhaustion, emaciation.
(2) Salivation; stomatitis.
(3) Increase and alteration of secretions, which become thin and excoriate.
(4) Ulceration of skin and mucous membranes.
(5) Perspiration which do not relieve and are foul smelling.
(6) Thirst, with moisture of mouth and tongue.
(7) Aggravation of all symptoms at night and from the warmth of the bed.
(8) Moist eczema and intertrigo.
(9) Nocturnal bone pains.
(10) Low-grade suppurations, which are acrid and blood- stained.
(11) Tremors of coarse character that tend to become convulsive.
(12) Green, bloody or mucous stools with tenesmus, “a cannot get done feeling.”
(13) Foul body smell (med., psor.).
(14) Mercurial symptoms occurring in syphilis.
(15) Catarrhs of mucous membranes, with increased mucus.
(16) Light-haired persons with lax skin and muscles (dark- haired, nitric ac.).
-From both heat and cold, warmth of bed, at night, draughts, bending forwards (stomach complaints), after eating, lying on the right side, touch and pressure, motion and exertion, sweat food, lamplight and firelight (eyes).
From rest, weeping, coitus.
The salts of mercury have the same general therapeutic applications as the pure metal, but they are modified by the acid ion and are thereby made especially suitable in certain conditions. We will now consider them with regard to their particular provinces.