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Mercurius, a study
Mercurius, a study D . M. G I B S O N ,
M . B . , B . S . L O N D . , F . R . C . S . E D I N . , F.F.HOM.
PHAI~MACOGNOSY
Mercurius solubilis, also known as Mcrcurius oxydulatus niger from its black colour, was the ammonium nitrate salt of mercury introduced by Hahnemann into medicine in 1788. I t was also used by him in "provings". However, the preparation of the salt "required much care and labour", and Hahnemann in accordance with the precept--quod fieri potest per pauca, non debet fieri per plura--recommended triturations of metallic mercury, Mercurius virus, as being of equivalent value therapeutically. The two preparations, therefore, may be considered as one from the Materia Medica angle. Mercury was not used medicinally before the fifteenth century. The employment of mercury, which in its poisoning effects can produce symptoms similar to those of syphilis, as a cure for the pox was an early example of inadvertent Homceopathy. PHAI~MACOLOGY
Mercury is a general poison having affinity with a wide range of tissues, notably mucous membranes, bones, salivary glands, lymph nodes, liver, kidneys, nervous system, blood and skin. Inflammatory lesions are produced tending to degenerative changes, especially necrosis of tissues. I t is recorded that the symptoms of mercury poisoning range through erethism, stomatitis, sialorrhoea, tremors, skin rashes to albuminuria and the nephrotic syndrome. Dysphonia, dysarthria, ataxia and severe constriction of visual fields have also been described. PHYSIOGNOMY
The Mercurius subject has usually a sickly, even caehectie, appearance. The face shows yellowish pallor or a lead-coloured earthy look, with dull lustreless eyes. A bloated look may be noticed, especially round the eyes which are encircled by a bluish red discoloration. The face may be covered with perspiration, but the lips are dry, rough and blackish. They may show pustules, scabs or small ulcers. Rhagades are common at the corners of the mouth. A pale, swollen, flabby tongue shows the imprint of the teeth; it is usually quite moist, but fairly thickly coated. Foctor oris is pronounced and the whole body odour is offensive. General tremors may be evident, and the hands so shaky as to make writing impossible. Speech may be hurried and rapid, but is perhaps more often slow with long pauses before answering questions.
MERCURIUS,
A STUDY
31
PSYCHOLOGY
The subject is restless, agitated, a n g u i s h e d l j u s t cannot stay still for one minute. There is often excessive fear from quite trivial cause. Mental turmoil and torment is most pronounced at night, associated with a desire to flee, to escape, and a feeling "as if he had committed a crime". The mind is weak and tremulous; memory and will-power are i m p a i r e d - is apt to forget names of people, of streets, of places et sic. At times feels hurried and does things in great haste. The mental state m a y be one of extreme indifference, of homesickness, of suicidal or even murderous intent. PHYSIOLOGY
The Mercurius patient is essentially a chilly person, especially when out of doors and in the evening. Flashes of heat in the face m a y coincide with shuddering and icy cold extremities. H e a t and cold sensations m a y alternate or intermingle. A peculiar creeping chilliness precedes the onset of coryza, fevers and malaise from other causes, and is rendered more noticeable b y uncovering, even slightly. Hunger m a y be constant and insatiable, but there is an aversion from meat, fat and butter. There is intolerance for sweets. Thirst is intense and excessive, despite the presence of a moist tongue. I t is a burning thirst for cold drinks, especially for milk or beer. Excessive drowsiness makes keeping awake difficult in the daytime, but insomnia of various types and degrees disturbs sleep at night. Vivid, often terrifying, dreams cause frequent waking which m a y be accompanied b y palpitations or sweats. Sweats are profuse, offensive, of sickly or nauseous odour, and stain linen yellow. They afford no relief, however. Modalities. There is aggravation from either extreme of temperature, in a warm room or a warm bed; also from change in weather, especially to humid or rainy weather, and from the least draught. Perhaps the most important modality is severe aggravation at night, but the sufferer is also worse in the evening, when lying on the right side, from touch and pressure, from eating and from sweating. The a u t u m n is a bad time. Some relief is obtained when at rest, and the subject feels better at high altitudes. PATHOLOGY
General. A feature of Mercurius is very easy exhaustion after quite slight exertion. There is a tendency to emaciation and paretie weakness associated with a liability to fainting attacks or sudden myocardial failure. Blood dyscrasias occur, resulting in profound anaemia which renders the subject liable to ready suppuration, characterized by sanious pus or necrotic ulceration. Anasarca of face, hands and lower extremities m a y develop. Head. Vertigo associated with stumbling or swaying is especially noticed on rising from bed or from sitting. Headache is severe; the whole head is tender to the touch, feels compressed as if in a vice, or it m a y feel as if growing larger or being pressed on from above. Boring pains occur in the head, notably in the left temple or occiput. Head-
32
THE
BRITISH
HOM(:EOI~ATHIC
JOUI~:NAL
ache is worse at night and on waking, but better when up and moving around. Hair tends to fall out. The scalp is extremely itchy. Skull bones necrose.
Eyes. Various inflammatory eye conditions are described which are aggravated b y the heat of a fire or a stove, and also worse at night. Photophobia is very severe, and vision is dimmed, with a mist before the eyes or seeing black specks floating around. Severe neuralgic pain m a y be felt in the eye associated with a sensation of cold all round the orbit. Ears. Otitis media is accompanied by lancinating pain and a purulent, offensive, excoriating discharge. The pain is especially severe at night. Tinnitus of roaring type m a y occur. Respiratory system. Frequent sneezing m a y occur without actual coryza. The bridge of the nose m a y be swollen. Actual caries of nasal bones m a y be present or necrotic ulcers inside the nose. The associated discharge is acrid, often yellowish green in colour, and the nostrils are raw and sore. There is a liability to epistaxis with blood which coagulates easily, perhaps causing a clot to dangle from the nostril. The throat feels very dry and swallowing is painful, but owing to excessive salivation frequent swallowing is unavoidable. Ulcerative tonsillitis occurs. Cough is worse at night, and suffocative paroxysms occur with an inclination to vomit. There is a good deal of mucopurulent sputum. The cough is aggravated when lying on the right side. Stitching pains occur in the chest, especially in the pectoral regions. Involvement of the right lower lobe is accompanied by sharp pains shooting through to the back. Haemoptysis m a y occur. Alimentary system. A foul mouth is associated with much soapy, slimy or stringy saliva. The tongue is moist, flabby and indented at the edges by contact with the teeth. I t m a y be swollen. Greyish ulcers m a y be present on the buceal aspect of the cheeks, on tongue, gums and palate. An unpleasant taste is noticed in the mouth, metallic, salty or like rotten eggs. Teeth are apt to ache, especially at night, and the pain is aggravated b y taking either hot or cold fluids; it is eased somewhat by rubbing the contiguous cheek. Teeth m a y feel "too long", become loose and be discoloured, turning black. Gums become swollen, recede and bleed very easily. Involvement of the liver results in biliousness, jaundice, ascites, and inability to lie on the right side. Pyrosis, violent vomiting, extreme epigastric tenderness, and other forms of gastric distress are described, generally made worse on bending forwards. Pinching pains occur in the belly. Hiccough is frequent. Excoriating watery diarrhoea m a y occur, especially toward evening, with bright yellow, green or dark brown stools; and great exhaustion follows the passage of the stool. Actual dysentery m a y be present with slimy, blood-stained stools, severe tenesmus and the "never get done" sensation. The stools are very foetid in odour. In very severe attacks Mercurius corrosivus is of signal value.
~IERCURIUS,
A
STUDY
33
Lymphatic and glandular systems. Involvement of lymph nodes is common, especially in the cervical and inguinal regions, with a strong tendency to suppuration and abscess formation. Painful swelling of the salivary glands also Occurs.
Urinary system. Frequency and urgency of urination may be present both day and night, only small quantities of urine being passed, and with the accompaniment of much burning both during and after the act. The urine excoriates. Nephritis with generalized anasarca may be present. Genital system. The testicles may become swollen and indurated, associated with a feeling of coldness in the parts. Priapism may be painful and persistent. Chancre, bubo, balanitis, greenish urethral discharge are associated with the remedy. Ovarian pains may occur of a stinging and burning nature. Lactation has been observed in non-pregnant women during the menstrual period. Leucorrhoea is greenish and is more marked in the evening, during the night and when urinating. I t tends to be accompanied by severe pruritus which is relieved by cold bathing. Ulcers occur on the cervix and vulva. Nervous system. Neuromuscular inco-ordination is a frequent feature. Tremors are prominent causing difficulty in grasping small objects. The tremors may be so violent as to throw the patient down, or they may take the form of constant choreic movements associated with difficulty in articulation and indistinct speech. The tremulousness is aggravated by exposure to the least draught, by even slight exertion and by emotional stress. Locomotor system. Burning and drawing pains occur in the nape and back accompanied by rigidity. Sacral pain tends to spread to the thighs. Caries of the spine may be present with stitching pains in the thighs, worse on walking. Severe pain is felt in the bones, especially at night, when warm in bed. Cramplike pains occur in the hands with stiffness suggestive of tetany. A bruised weariness in the lower limbs causes restless unease of limbs which makes it impossible to keep still or stay put, even in bed. Joints become painful, puffy, pale and tender, and the pain is worse both from the heat of the bed and also from uncovering. Skin. Eruptions occur of many varieties, but arc inevitably aggravated by extremes of temperature and at night. Ulcers tend to spread rapidly, are serpiginous in outline, have a yellow sloughing base and a foul foetid discharge. Excoriations occur in contact areas. Fissures may be present in hands and feet. Severe pruritus is common in various sites, worse in the evening and at night. POSOLOGY
The remedy is indicated in syphilitic lesions. I t is often of value in cachectie conditions due to malignant disease or tuberculosis. Low potencies tend to hasten suppuration; high may abort. Mercurius a n d Silicea are inimical if either is given in sequence to the other before the action of the first dose is completed. Mercurius is seldom indicated if the tongue is dry.
M . B . , B . S . L O N D . , F . R . C . S . E D I N . , F.F.HOM.
PHAI~MACOGNOSY
Mercurius solubilis, also known as Mcrcurius oxydulatus niger from its black colour, was the ammonium nitrate salt of mercury introduced by Hahnemann into medicine in 1788. I t was also used by him in "provings". However, the preparation of the salt "required much care and labour", and Hahnemann in accordance with the precept--quod fieri potest per pauca, non debet fieri per plura--recommended triturations of metallic mercury, Mercurius virus, as being of equivalent value therapeutically. The two preparations, therefore, may be considered as one from the Materia Medica angle. Mercury was not used medicinally before the fifteenth century. The employment of mercury, which in its poisoning effects can produce symptoms similar to those of syphilis, as a cure for the pox was an early example of inadvertent Homceopathy. PHAI~MACOLOGY
Mercury is a general poison having affinity with a wide range of tissues, notably mucous membranes, bones, salivary glands, lymph nodes, liver, kidneys, nervous system, blood and skin. Inflammatory lesions are produced tending to degenerative changes, especially necrosis of tissues. I t is recorded that the symptoms of mercury poisoning range through erethism, stomatitis, sialorrhoea, tremors, skin rashes to albuminuria and the nephrotic syndrome. Dysphonia, dysarthria, ataxia and severe constriction of visual fields have also been described. PHYSIOGNOMY
The Mercurius subject has usually a sickly, even caehectie, appearance. The face shows yellowish pallor or a lead-coloured earthy look, with dull lustreless eyes. A bloated look may be noticed, especially round the eyes which are encircled by a bluish red discoloration. The face may be covered with perspiration, but the lips are dry, rough and blackish. They may show pustules, scabs or small ulcers. Rhagades are common at the corners of the mouth. A pale, swollen, flabby tongue shows the imprint of the teeth; it is usually quite moist, but fairly thickly coated. Foctor oris is pronounced and the whole body odour is offensive. General tremors may be evident, and the hands so shaky as to make writing impossible. Speech may be hurried and rapid, but is perhaps more often slow with long pauses before answering questions.
MERCURIUS,
A STUDY
31
PSYCHOLOGY
The subject is restless, agitated, a n g u i s h e d l j u s t cannot stay still for one minute. There is often excessive fear from quite trivial cause. Mental turmoil and torment is most pronounced at night, associated with a desire to flee, to escape, and a feeling "as if he had committed a crime". The mind is weak and tremulous; memory and will-power are i m p a i r e d - is apt to forget names of people, of streets, of places et sic. At times feels hurried and does things in great haste. The mental state m a y be one of extreme indifference, of homesickness, of suicidal or even murderous intent. PHYSIOLOGY
The Mercurius patient is essentially a chilly person, especially when out of doors and in the evening. Flashes of heat in the face m a y coincide with shuddering and icy cold extremities. H e a t and cold sensations m a y alternate or intermingle. A peculiar creeping chilliness precedes the onset of coryza, fevers and malaise from other causes, and is rendered more noticeable b y uncovering, even slightly. Hunger m a y be constant and insatiable, but there is an aversion from meat, fat and butter. There is intolerance for sweets. Thirst is intense and excessive, despite the presence of a moist tongue. I t is a burning thirst for cold drinks, especially for milk or beer. Excessive drowsiness makes keeping awake difficult in the daytime, but insomnia of various types and degrees disturbs sleep at night. Vivid, often terrifying, dreams cause frequent waking which m a y be accompanied b y palpitations or sweats. Sweats are profuse, offensive, of sickly or nauseous odour, and stain linen yellow. They afford no relief, however. Modalities. There is aggravation from either extreme of temperature, in a warm room or a warm bed; also from change in weather, especially to humid or rainy weather, and from the least draught. Perhaps the most important modality is severe aggravation at night, but the sufferer is also worse in the evening, when lying on the right side, from touch and pressure, from eating and from sweating. The a u t u m n is a bad time. Some relief is obtained when at rest, and the subject feels better at high altitudes. PATHOLOGY
General. A feature of Mercurius is very easy exhaustion after quite slight exertion. There is a tendency to emaciation and paretie weakness associated with a liability to fainting attacks or sudden myocardial failure. Blood dyscrasias occur, resulting in profound anaemia which renders the subject liable to ready suppuration, characterized by sanious pus or necrotic ulceration. Anasarca of face, hands and lower extremities m a y develop. Head. Vertigo associated with stumbling or swaying is especially noticed on rising from bed or from sitting. Headache is severe; the whole head is tender to the touch, feels compressed as if in a vice, or it m a y feel as if growing larger or being pressed on from above. Boring pains occur in the head, notably in the left temple or occiput. Head-
32
THE
BRITISH
HOM(:EOI~ATHIC
JOUI~:NAL
ache is worse at night and on waking, but better when up and moving around. Hair tends to fall out. The scalp is extremely itchy. Skull bones necrose.
Eyes. Various inflammatory eye conditions are described which are aggravated b y the heat of a fire or a stove, and also worse at night. Photophobia is very severe, and vision is dimmed, with a mist before the eyes or seeing black specks floating around. Severe neuralgic pain m a y be felt in the eye associated with a sensation of cold all round the orbit. Ears. Otitis media is accompanied by lancinating pain and a purulent, offensive, excoriating discharge. The pain is especially severe at night. Tinnitus of roaring type m a y occur. Respiratory system. Frequent sneezing m a y occur without actual coryza. The bridge of the nose m a y be swollen. Actual caries of nasal bones m a y be present or necrotic ulcers inside the nose. The associated discharge is acrid, often yellowish green in colour, and the nostrils are raw and sore. There is a liability to epistaxis with blood which coagulates easily, perhaps causing a clot to dangle from the nostril. The throat feels very dry and swallowing is painful, but owing to excessive salivation frequent swallowing is unavoidable. Ulcerative tonsillitis occurs. Cough is worse at night, and suffocative paroxysms occur with an inclination to vomit. There is a good deal of mucopurulent sputum. The cough is aggravated when lying on the right side. Stitching pains occur in the chest, especially in the pectoral regions. Involvement of the right lower lobe is accompanied by sharp pains shooting through to the back. Haemoptysis m a y occur. Alimentary system. A foul mouth is associated with much soapy, slimy or stringy saliva. The tongue is moist, flabby and indented at the edges by contact with the teeth. I t m a y be swollen. Greyish ulcers m a y be present on the buceal aspect of the cheeks, on tongue, gums and palate. An unpleasant taste is noticed in the mouth, metallic, salty or like rotten eggs. Teeth are apt to ache, especially at night, and the pain is aggravated b y taking either hot or cold fluids; it is eased somewhat by rubbing the contiguous cheek. Teeth m a y feel "too long", become loose and be discoloured, turning black. Gums become swollen, recede and bleed very easily. Involvement of the liver results in biliousness, jaundice, ascites, and inability to lie on the right side. Pyrosis, violent vomiting, extreme epigastric tenderness, and other forms of gastric distress are described, generally made worse on bending forwards. Pinching pains occur in the belly. Hiccough is frequent. Excoriating watery diarrhoea m a y occur, especially toward evening, with bright yellow, green or dark brown stools; and great exhaustion follows the passage of the stool. Actual dysentery m a y be present with slimy, blood-stained stools, severe tenesmus and the "never get done" sensation. The stools are very foetid in odour. In very severe attacks Mercurius corrosivus is of signal value.
~IERCURIUS,
A
STUDY
33
Lymphatic and glandular systems. Involvement of lymph nodes is common, especially in the cervical and inguinal regions, with a strong tendency to suppuration and abscess formation. Painful swelling of the salivary glands also Occurs.
Urinary system. Frequency and urgency of urination may be present both day and night, only small quantities of urine being passed, and with the accompaniment of much burning both during and after the act. The urine excoriates. Nephritis with generalized anasarca may be present. Genital system. The testicles may become swollen and indurated, associated with a feeling of coldness in the parts. Priapism may be painful and persistent. Chancre, bubo, balanitis, greenish urethral discharge are associated with the remedy. Ovarian pains may occur of a stinging and burning nature. Lactation has been observed in non-pregnant women during the menstrual period. Leucorrhoea is greenish and is more marked in the evening, during the night and when urinating. I t tends to be accompanied by severe pruritus which is relieved by cold bathing. Ulcers occur on the cervix and vulva. Nervous system. Neuromuscular inco-ordination is a frequent feature. Tremors are prominent causing difficulty in grasping small objects. The tremors may be so violent as to throw the patient down, or they may take the form of constant choreic movements associated with difficulty in articulation and indistinct speech. The tremulousness is aggravated by exposure to the least draught, by even slight exertion and by emotional stress. Locomotor system. Burning and drawing pains occur in the nape and back accompanied by rigidity. Sacral pain tends to spread to the thighs. Caries of the spine may be present with stitching pains in the thighs, worse on walking. Severe pain is felt in the bones, especially at night, when warm in bed. Cramplike pains occur in the hands with stiffness suggestive of tetany. A bruised weariness in the lower limbs causes restless unease of limbs which makes it impossible to keep still or stay put, even in bed. Joints become painful, puffy, pale and tender, and the pain is worse both from the heat of the bed and also from uncovering. Skin. Eruptions occur of many varieties, but arc inevitably aggravated by extremes of temperature and at night. Ulcers tend to spread rapidly, are serpiginous in outline, have a yellow sloughing base and a foul foetid discharge. Excoriations occur in contact areas. Fissures may be present in hands and feet. Severe pruritus is common in various sites, worse in the evening and at night. POSOLOGY
The remedy is indicated in syphilitic lesions. I t is often of value in cachectie conditions due to malignant disease or tuberculosis. Low potencies tend to hasten suppuration; high may abort. Mercurius a n d Silicea are inimical if either is given in sequence to the other before the action of the first dose is completed. Mercurius is seldom indicated if the tongue is dry.