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hours. At such times the extremities were always ice cold and the face flushed.
Two or three times when she was given a hot bath to equalize the circulation, she had the muscular twitchings and convulsive seizures so marked that it was deemed unwise to repeat them.
At the end of three weeks she was able to come to my office semi-occasionally and to resume outdoor exercise.
The sleep at night was natural, and she took a nap during the afternoon. The appetite improved and she no longer had these comatose spells.
She improved so nicely that her folks became rather careless and allowed her to read and study more than I had specified, and on January 17 she started in with that nervous hacking cough, and developed one of those spells of coma and delirium and convulsions more exaggerated than any that she had experienced.
This was followed about the same time next day by a similar attack, which was repeated the day following, although with increased severity.
I told the parents that I did not think that she would die; the pulse was good, the kidneys active and the menstruation had been normal, but as they were greatly alarmed I suggested a consultation.
Dr. Simmons looked at the case with me on January 19, agreed with me that there was no danger signal, and that a cure was only a matter of time, which might, however, be somewhat prolonged, and told me of a case that he had recently which was almost precisely similar, and which he had cured by sepia.
Acting on the suggestion, I gave the drug to this patient, but without much result. After three or four days, however, the paroxysms lessened, and finally ceased altogether, although she had a severe frontal headache at the time of the morning that they usually appeared. She also had the sensation that voices in the room sounded as though they were a great distance off.
Improvement continued daily, and she was able to resume her walks and her ordinary household duties, although I counselled her parents that any undue worry or excitement, mental application, as excessive reading or study, would be liable to precipitate another attack. So far she has been free from them. The remedies which seemed most useful were asafoedita, belladonna, cedron, caulophyllum, gelsemium, hedeoma, ignatia and pulsatilla.
Under ignatia we find the oppression of the chest, the severe frontal headache, clavus hystericus, general increased sensibility and convulsions.
Cedron for periodicity, that being the keynote of the drug, the fits coming on at about the same time each day, and lasting for a few minutes to several hours.
Hedeoma seemed to fit the case very well, the prominent symptoms of this drug being the extreme coldness of the hands and feet, the body being warm (belladonna has this symptom prominent in its pathogenesis, also the convulsive twitchings), and the shortness of breath noticed only during these spells of coma.
Under pulsatilla we have the heightened sensitiveness, the irritability, the melancholy and excessive dread in delirium.
A COMPARISON OF THE THERAPEUTIC INDICATIONS FOR THE DIFFERENT PREPARATIONS OF MERCURY.*
By H. D. COCHRANE, M.D.,
Bedford, N. Y.
T is not without a feeling somewhat akin to that of veneration that
we approach the consideration of that greatest of therapeutic agents of the mineral kingdom-Mercurius: a drug that has been the ultima ratio equally of the bold, the desperate and the timid. The all-potent mineral has received the laudations of the skillful and of the ignorant, of the learned and unlearned alike; to the one a powerful lever to bear him over great difficulties, and to the other a last resource beneath which he might shelter his want of knowledge, and a universal panacea upon which his conscience might repose blameless.
In our pharmacopeia of to-day there are many drugs, the physiological action of which we know little, and the curative powers of which we know less. Not so with mercury. Were we to trace its history down the centuries we would be led back to the days of Aristotle and Pliny, and sitting at the feet of Galen and Paracelsus learn from these fathers of medicine the power of hydrargyrum over disease.
During such a long career, the reputation of mercury has not escaped without receiving many a scar. It has been the battlefield upon which have been raged long and fierce conflicts between its staunch advocates on the one hand and its bitter foes on the other.
* Alumni prize essay 1898, New York Homeopathic Medical College.
Why should the medical world have been so divided regarding its therapeutic usefulness? We have but to look over the clinical experience of all these years to find the answer; its indiscriminate administration regardless of indications and quantity was occasionally associated with return of health; but more often it produced the most dire results, causing disintegration of animal tissue, decomposing the vital fluids, destroying the plasticity of the blood, prostrating the reproductive functions, and lowering man to a condition little better than that of brute creation. Such has been the picture time and again afforded us by clinical experience when the drug has been used for any length of time to combat disease.
We fain would utilize this mighty agent in our struggle against the enemy; but in order to benefit the few must the penalty be borne. by the many, must man's noble energies be blasted under its influence ?
This need not be; turn from your miserable empiricism and listen to the teachings of him whose heroic devotion to medical truth has converted the deadliest poisons into harmless and yet allpowerful restorers of health. It was reserved for Samuel Hahnemann to convert this destructive agent into a beneficent harbinger of health.
The mercurial group might be likened to a mountain range composed of many peaks, having certain grand characteristics in common, as age, formation and flora, yet differing in minor details regarding altitude, form and name. So in the group under consideration, there are certain cardinal characteristics in which all the members participate, and again each preparation has certain indications which are peculiar to itself, acquired by virtue of its combination with other agents, thus gaining a therapeutic identity of its own.
It is our object at this time to compare the therapeutic indications of these different preparations. Before doing so, let us glance first at a few of the cardinal characteristics common to all the mercuries, and then consider briefly some of the indications peculiar to each member of the group.
The striking keynote of the mercuries is their adaptability to mucous and parenchymatous inflammations, with tendency to ulceration and suppuration, the ulcers are superficial and tend to spread, all the discharges are offensive and acrid. A free oily sweat, which affords no relief, is always present when mercury is indicated, also increased salivation, with a thick, flabby tongue, showing the imprints of the teeth. All the conditions are aggravated at night and from the warmth of the bed, especially the bone pains.
Mercurial Preparations. The American Pharmacopeia recognizes fifteen preparations of mercury, two of which are the mineral per se, the remainder being chemical combinations of hydrargyrum, with other elements and compounds. The following is the list:
I. Mercurius solubilis Hahnemanni. 2. Mercurius vivus. 3. Mercurius iodatus flavus (protoiodide). 4. Mercurius iodatus ruber (biniodide). 5. Mercurius sublimatus corrosivus. 6. Mercurius dulcis (calomel). 7. Mercurius cyanatus. 8. Mercurius sulphuratus ruber (cinnabar). 9. Mercurius sulphuricus. 10. Mercurius sulphuretum nigrum. II. Mercurius precipitatus albus.
12. Mercurius precipitatus ruber. 13. Mercurius aceticus. 14. Mercurius nitrosus. 15. Mercurius auratus.
They naturally divide themselves into two groups, the first seven being in constant use; the remaining eight have a much more restricted sphere of usefulness.
Merc. Sol. et Merc. Vivus.-Mercurius solubilis Hahnemanni, the ammonia-nitrate of mercury, and mercurius vivus, triturated quicksilver, as regards their therapeutic fields, have been found by clinical experience to be practically identical, and may be used interchangeably; at least such is the opinion of most authorities, though in Allen's Encyclopedia their symptoms are arranged under separate headings; we will consider them as a unit under the term Merc.. vivus, the cardinal indications for which we have already considered under the characteristics of mercury in general.
Merc. Prot. et Merc. Bin.—The union of mercury with iodine gives us valuable agents, namely, mercurius protoiodide and biniodide. Their field is primarily in the throat, involving the glandular apparatus, especially in troubles due to a syphilitic or scrofulous diathesis. The protoiodide has a special affinity for right-sided affections, with a tongue yellow-coated at the base and a clean tip. The biniodide, owing to its double equivalent of iodine, is the greater irritant, hence it is characterized by more fever and glandular enlargement; it selects the left side for its field of action.
Merc. Cor. et Merc. Dulc.—Next on our list we find mercurius corrosivus and dulcis, combinations of mercury with another member of the halogen group, chlorine. It is here we find the extreme limits of the action of the mercurial preparations meet; merc. cor. exerting the most profound, and merc. dulcis the mildest effect, of any of the group upon the organism. The former is a specific irritant to the living tissues, exerting a stronger elective affinity for certain tissues than merc. viv., and producing inflammatory symptoms of the most violent character, with burning, agonizing pains.
Merc. dulcis causes, and consequently cures, scrofulous conditions in children with anemia, swelling of the cervical and other glands, the skin being flabby, bloated and ill-nourished,
Merc. Cyan.---Mercurius cyanatus, a combination of mercury with hydrocyanic acid, exerts a profound influence upon the system. It differs from the bi-chloride in that it does not corrode tissue, consequently its action is of dynamic origin. Its keynotes are great prostration and feebleness of circulation and respiration.
Lesser Preparations.—The remaining members of the group lave little that is characteristic in their action, and their selection is largely based upon clinical precedent rather than upon pathogenetic symptoms. We will refer to them later as occasion may require.
We are now in a position to consider the comparative therapeutic indications of these different preparations of mercury. Let us do so upon an anatomical basis. We shall use specific terms for various pathological conditions and groups of symptoms; but let us remember, in so doing, it is simply for clinical convenience, the selection of our remedy being at all times based upon the totality of the symptoms, and not upon an arbitrary nomenclature of disease.
Mind. -In melancholia merc. vivus is useful when there is inexpressible anxiety of soul and body, and an anxious restlessness with fear of some impending evil; the victim imagines every one his enemy. Such a mental state following syphilis would lead us to select merc. prot.
Sleeplessness.—The merc. vivus patient is apprehensive, dreads to fall asleep, and tosses about without knowing why; whereas one requiring merc. corrosivus can't sleep on account of vertigo and anxiety, resulting from lowered conditions of vitality.
Head. —The keynote of the headache of merc. vivus is the feeling of fullness, giving rise to the sensation of a tight bandage around the head, intensified by hot or cold applications.
Merc. cor. cures a somewhat similar but more intense headache, with more vertigo, and is relieved by cold applications.
In merc. prot. we find a right-sided headache, relieved by diverting the patient's mind from himself.
The headache of cinnabar is of the neuralgic type; the pains run around the eye from one canthus to the other; there is the sensation of weight, as of a pair of heavy spectacles over the nose.
Eye. —Mercury is one of the chief remedies in ophthalmic practice, especially in inflammations of scrofulous or syphilitic origin.
The merc. vivus patient suffers greatly from the glare and heat of the fire, the lids are thickened and the eyes discharge a thin muco