Modus Operandi of Mercury.
Selected writings of John King:
This article is one of the earliest penned by Dr. King, and perhaps is the first to appear in an Eclectic medical publication. It is characteristic of the man, who ever sought to be fair to antagonists and bring about the desired reforms by educational methods. While many of the rank and file of the Reformers, and more especially those who took refuge under the banners of the new movement, were tactless, often uncultured, and more often abusive toward those of opposite faith, the leaders of the movement for medical Eclecticism preferred to use sound arguments and educational methods to gain their point. In the beginning mercury as well as other minerals were practically proscribed. With the leaders, however, there shortly came a change from proscription to restriction, and after the first few years Eclectic literature shows rather the trend toward a warfare against the abuse and not against the use of mercurials. Nevertheless, so well-grounded did the opposition become to this class of medicines, the horrors of which were everywhere apparent (and now admitted by old school writers), that few of the earlier Eclectics would ever employ a mercurial salt internally or externally; a prejudice still maintained by some Eclectic practitioners. Dr. King's paper was published at a time when nearly all the authorities of the, old school disclaimed any knowledge of the manner in which mercury operated physiologically or chemically. The chemical theory he advanced, that it is converted into an oxide, though vaguely hinted at by others, became the prevailing theory for many years. Much dissension is shown at the present day over the question as to the form in which mercury enters the circulation, some contending as an oxyalbuminate, or with Miahl of France, that all mercury compounds are transformed into the bichloride in the stomach and bowels, and uniting in the blood with sodium chloride, become converted into a double chloride of sodium and mercury; or with Henoch of Germany, that an albuminate is produced, or as claimed by Voit, also of Germany, a chloroalbuminate. It is generally accepted that it is eliminated as an albuminate. "All these theories," says Hare, "as to its absorption are open to grave criticism." Therefore it would appear that with all the enlightenment possible from the advantages of chemical and physiologic equipment of to-day, we are little nearer an explanation of the modus, operandi of the mercurials than was the scientific physician of seventy years ago. John King's theory as to its absorption as an oxide lacked but a step to that now accepted by many—that it enters the circulation as an oxyalbuminate. It must be remembered that the chemistry of the albumens is of much more recent elaboration. The value of this paper consists in exhibiting the fact that the early Eclectics were not wholly uncultivated nor ignoramuses, as some would have us believe, but that such leaders as King were thoroughly grounded in the chemical knowledge of the day and that the mass of Eclectic physicians welcomed scientific explanations; for a few years later Dr. King was asked to republish this paper, which was used widely as a weapon in the warfare for the abolition of mercurial abuses.—Ed. Gleaner.
MODUS OPERANDI OF MERCURY.—Messrs. Editors: It may not be amiss to lay before your readers the modus operandi of mercury, or the method by which it acts upon the human system, producing the many evil effects which are constantly witnessed from its internal administration.
The evils resulting from the employment of this mineral are not confined to the observation of a few, but are reiterated again and again by nearly all medical writers, and indisputably establish the fact that mercury ought never to be used as a medicinal agent; nevertheless, it is still resorted to for almost every disease by the physician; nor can we be surprised at it, when we are presented with such a medley of theories, and such discordant practice, as the various professors of medicine issue from time to time.
The student trained by his teachers to adopt a certain course of treatment, based upon certain principles, is ushered forth into the world as a practitioner of medicine, being highly prejudiced in favor of the particular theory and practice which have been taught him, and considering every other as absurd and empirical. In due time he is called to the bedside of the sick; he prescribes, but all his skill is exerted in vain: he loses his patient. Nothing discouraged, he continues in his unsuccessful career, until after a practice of six or eight years, he arouses, as it were, from a dream, and discovers the utter futility of the theory and practice of his professors. He now searches for something new; he finds it,—a celebrated medical author has advanced new ideas on the theory and practice of medicine, he seizes them with avidity, and adopts them; but a similar misfortune awaits him,—his patients still continue to die, notwithstanding he has dosed them largely, or minutely as the case may be; until, after having ineffectually followed the various plans suggested by writers, he finally settles down into an entire state of carelessness, considering it a matter of indifference as to the recovery or non-recovery of big patients; and is satisfied that be has done his duty, by bleeding and doses of mercury, simply because all authors, however different their theories may be, agree in some measure to the adoption of such means.
This is a correct statement of the practice and experience, as many significantly express it, of more than three-fourths of our physicians. And truly a lamentable statement it is, for in reality the more experienced the physician becomes, the more ignorant is he of the true principles of his profession; unless, indeed, he be one of those noble, philosophic souls who dares to break down the prejudices by which he is surrounded, and boldly examine for himself, without desire for future fame, or care for the scorn and malice of his blinded fellow physicians.
But, without further digression, let us enquire, do physicians understand how, or why, this metal produces its action upon the human system? We have conversed with many physicians upon this subject, but could never obtain from them any more satisfactory reason, than that its irritating qualities, or its peculiar mode of action, is the cause.
This is certainly an incomprehensible reason for him who honestly wishes to arrive at the truth, and the very next question would be, how is this peculiar mode of action produced,—or how, acting merely as an irritant, so, many serious effects should result? If we refer to standard authority on this matter, we still remain in obscurity—thus, in the U. S. Dispensatory, under the article mercury, it is said:
"Of the modus operandi of mercury, we KNOW NOTHING except that it probably acts through the medium of the circulation, and that it possesses a peculiar alterative power over the vital functions, which enables it in many cases to subvert diseased action by substituting its own in their stead."
If such, then, is all the knowledge which physicians have of the action of this mineral—such all the satisfaction we can derive from them—and yet, notwithstanding this ignorance, they still continue to employ it; let us ask if this is not downright empiricism ? or if not, what is?
In Eberle's Therapeutics, we find the following remarks:
"Mercury," it is observed by Cullen, "acts as a stimulus to every sensible and moving fiber of the body. What is the peculiar character of the excitement which it produces may be, it would be in vain to enquire; but it appears, to be more permanent and universal, than that of any other medicinal agent with which we are acquainted."
We will now demonstrate the peculiar character of the excitement which mercury produces in the system, as ascertained by us several years ago, notwithstanding the bugbear assertion, that "it would be in vain to enquire,"
- Phosphoric acid pervades almost every fluid and solid of the human body, and is more abundant than any other acid.
- Phosphoric acid and lime, in the form of phosphate of lime, constitute the greater part of the composition of human bones.
- Phosphoric acid does not act upon mercury but, combines with its oxide, forming phosphate of Mercury.
- Phosphorus acid differs from phosphoric acid in containing one proportion less of oxygen, and decomposes all the oxides and salts of mercury—separating the mercury in its metallic state.
- Human bile which is, excreted by the liver, is composed of water, albumen, picromel, muriate of soda, phosphate of soda, phosphate of lime, soda and lime uncombined with any acid, etc.—hence the chemical character of the bile is alkaline.
- Saliva is composed of water, mucus, animal matter, alkaline muriates, lactate of soda, and pure soda.
- The mucous secretion from the mouth throughout the whole alimentary canal, with the exception of the gastric and pancreatic juices, as has been proven by M. Donne and others, is of an alkaline character.
- It is admitted by all chemists that acids and alkalies mutually decompose or neutralize each other, forming new combinations; also, that the affinity existing between acids and alkalies appears to be much greater, in general, than between any other known substances in nature.
- In whatever soluble form the usual preparations of mercury are introduced into, the stomach, they are reduced to an oxide of the metal previous to being absorbed into the system.
- Most acids are capable of combining with the oxides of mercury. By keeping the above facts in view, we can clearly understand the modus operandi of mercury.
Thus, when any salt of mercury, say, a dose of calomel, for instance, has been taken into the stomach, and as soon as it has passed through the lower orifice of the stomach, (pylorus) into the first intestine, or as sometimes, and more properly termed, the second stomach, (duodenum) it comes in contact with the bile, which is discharged from the liver into the bowels at this point. Here, in consequence of the affinity existing between the acid combined with the metal, and the alkali of the bile, the acid is separated, and forms with the alkali a new combination possessing three elements, while the mercury is left in the form of the black oxide, which is the natural oxide of this metal. And it may be opportune to mention here that any salt of mercury, when exposed to the action of the atmosphere for a sufficient length of time, will result in the black oxide.
By the above action a mutual decomposition takes place, both of the sub-muriate of mercury and the phosphate of lime of the bile, upon the principle called in chemical language, electric affinity. Thus, both the soda and the lime have a stronger affinity, or chemical attraction, for the muriatic acid of the calomel, than the affinity existing between the muriatic acid and the mercury. Hence the soda and lime combine with the muriatic acid, forming muriates of soda and lime, while a portion of phosphoric acid is set free by a decomposition of the phosphate of lime; and the mercury, by losing its acid, is reduced to an oxide. This is not only proved by chemical laws, but also confirmed by physiological facts. And in this manner calomel touches or acts upon the liver,—we may likewise understand why the discharges from the bowels produced by mercurial cathartics are invariably dark colored, like the black or gray oxide of mercury.
In the form of an oxide, then, is mercury carried into the mass of blood, to be thence circulated to every part of the system. Combining with the phosphoric acid of the bones, a phosphate of mercury is formed, leaving the bone in the state of an oxide of calcium, or common lime; the bony structure being thus chemically decomposed, crumbles and exfoliates.
A similar combination with the phosphoric acid of the nerves and brain produces nervousness, severe pains, loss of memory, headache, etc., and as the changes of the atmosphere act upon mercury in any state, the suffering patient can predict the various changes about to take place in the weather, with as much precision as could be derived from the most delicate barometer.
But pure mercury, or mercury in its metallic state, has been found in various parts of the bodies of those who have used it as medicine, by several celebrated anatomists; and how could this have been produced from its phosphate? We reply, not from the phosphate, but from the phosphite of mercury, which salt whenever formed separates after a time, freeing the phosphorous acid, and leaving the mercury in its metallic state.
Phosphorous acid may be produced by any element capable of abstracting from phosphoric acid a part of its oxygen. Phosphorous acid being thus formed, and coming in contact with the oxide of mercury, will form a phosphite of mercury, from which eventually the mercury will be precipitated or separated into its metallic state, in which state it may remain any indefinite period of time. This also affords a clue to an understanding of the statement made by Dr. Goldsmith in his natural history, that those miners who have been condemned to labor for life in mercurial ores often "transpire quicksilver at every pore" before death releases, them from their sufferings.
The oxide of mercury is capable of producing decomposition to some extent in every fluid or solid of the human body. And if any gentleman of the old school can disprove the above explanation of the modus operandi of mercury, I trust you will allow him the use of the columns of your journal, that is, if he dares to risk his reputation, or expose his ignorance, by attempting it.—J. KING, M. D., Western Medical Reformer, 1846. (Bear in mind that Calomel was amongst the five most prescribed drugs in America for SIXTY years.— MM)