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Mercurial diuretics
Editorial MERCURIAL
E
DIURETICS
in this issue there is found a personal account of the discovery of the diuretic action of certain mercurial compounds. The facts which led to this have not previously been published, so it seems particularly opportune that they should be presented on the thirtieth anniversary of the discovery. The history of Medicine would be more illuminated and enlivened if more of the simple beginnings were recorded. It would seem fair to state that this was the greatest advance in the treatment of chronic congestive heart failure since Withering published his classical account of digitalis in 1785. Whereas Withering received his tip, so to speak, from an empirical herbalist, it required shrewd observation and patient exclusion by trial and error to determine eventually the potent ingredient from a conglomerate mixture of herbs and roots which were the customary therapeutic preparations of his time. It might be held that his information came to him by chance, but others must have heard of the herbalist’s secret and did nothing about it. So may have been the case with the diuretic action of mercury. In the early years of the last century, a favorite preparation of digitalis was a pill combining one grain each of digitalis and squills. Squires’ Companion to the British Pharmacopoeia of 1871 lists a pill containing digitalis, squills, and blue mass. The amounts of each were found to vary in the formularies of the different hospitals-from one-half grain to one grain of digitalis and one to three grains of blue mass. The amount of squills also differed somewhat, but was usually one grain. This pill became known as Guy’s, Bailley’s, or Niemeyer’s pill, and it commonly contained one grain of each substance. The value of the digitalis and squills is easily understood, but why the mercury? It is not likely that it was for its purgative effect but probably rather because its combination with the other two was found to enhance their diuretic action. It must be further appreciated that a century ago pharmacology as we know it today did not exist. Drug therapy was entirely empirical and renal physiology practically unknown. Johanna could not have been an unusual case in herself. As Dr. Vogl points out, the unusual feature of this unconscious experiment was the careful and accurate record kept by the “diligent nurse.” The attending physicians were skeptical, but recorded and repeated facts spoke for themselves. The importance of accurate and inquisitive observation is, unfortunately, too often overlooked. This applies not only to the bedside but also to the laboratory. The halo of absent colonies about the growth of mold which Drummond saw on the Petri dish was not unique but the inquisitive mind was. Elaborate apparatus and complicated biochemical reactions cannot entirely supplant keen clinical observations. J.C.M. LSEWHERE
925
E
DIURETICS
in this issue there is found a personal account of the discovery of the diuretic action of certain mercurial compounds. The facts which led to this have not previously been published, so it seems particularly opportune that they should be presented on the thirtieth anniversary of the discovery. The history of Medicine would be more illuminated and enlivened if more of the simple beginnings were recorded. It would seem fair to state that this was the greatest advance in the treatment of chronic congestive heart failure since Withering published his classical account of digitalis in 1785. Whereas Withering received his tip, so to speak, from an empirical herbalist, it required shrewd observation and patient exclusion by trial and error to determine eventually the potent ingredient from a conglomerate mixture of herbs and roots which were the customary therapeutic preparations of his time. It might be held that his information came to him by chance, but others must have heard of the herbalist’s secret and did nothing about it. So may have been the case with the diuretic action of mercury. In the early years of the last century, a favorite preparation of digitalis was a pill combining one grain each of digitalis and squills. Squires’ Companion to the British Pharmacopoeia of 1871 lists a pill containing digitalis, squills, and blue mass. The amounts of each were found to vary in the formularies of the different hospitals-from one-half grain to one grain of digitalis and one to three grains of blue mass. The amount of squills also differed somewhat, but was usually one grain. This pill became known as Guy’s, Bailley’s, or Niemeyer’s pill, and it commonly contained one grain of each substance. The value of the digitalis and squills is easily understood, but why the mercury? It is not likely that it was for its purgative effect but probably rather because its combination with the other two was found to enhance their diuretic action. It must be further appreciated that a century ago pharmacology as we know it today did not exist. Drug therapy was entirely empirical and renal physiology practically unknown. Johanna could not have been an unusual case in herself. As Dr. Vogl points out, the unusual feature of this unconscious experiment was the careful and accurate record kept by the “diligent nurse.” The attending physicians were skeptical, but recorded and repeated facts spoke for themselves. The importance of accurate and inquisitive observation is, unfortunately, too often overlooked. This applies not only to the bedside but also to the laboratory. The halo of absent colonies about the growth of mold which Drummond saw on the Petri dish was not unique but the inquisitive mind was. Elaborate apparatus and complicated biochemical reactions cannot entirely supplant keen clinical observations. J.C.M. LSEWHERE
925