Mercurius syllables. [2(NH2Hg2) NO3H2O]. Solution. Mercurius vivus. (Hg.) Trituration.
INTRODUCTION
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.
PATHOGENESIS.
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.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,