Gambar halaman
PDF
ePub

nouncing a verdict against it. The only reason why we do not more frequently hear the death of a neighbor attributed to calomel, is because we have become so familiar with it as a remedy, that we think of it in no other light.

An old medical writer (Hoffman), so old, indeed, that his books are unknown, except by name, to a large portion of the profession, mentions two cases of the fatal action of calomel, in boys from 12 to 15 years of age. Neither of these fell as if shot by a rifle, or instantly killed by prussic acid. The one died on the sixth day, after vomiting severely, having constant tremors of the extremities, restlessness and great anxiety; the other did not live quite so long a period. Even yet farther back, we find the injurious effects of calomel noticed. In 1692, according to the Miscellanea Curiosa, death was the result of half an ounce of calomel, taken accidentally; vomiting soon came on, slight acridity of the throat and fauces, profuse darkness, prostration of strength and torpor of the external senses; death, in a little over 24 hours, closed the scene. In this case, the poisonous dose was taken accidentally; and can it excite wonder that doses quite as large, given by design, and even for good ends, should kill in 24 hours, or after the lapse of a longer period?

Some doubt has been expressed as to the irritant quality of calomel, but, as I think, unnecessarily. That it is an irritant, in many cases, all the symptoms conspire to make manifest; yet, if it be taken in excessive portions, it may evince a direct sedative or narcotic power, may paralyze the stomach and bowels, and kill, without effecting a single evacuation. The various and even opposite action of calomel, as here hinted at, is witnessed by practitioners repeatedly; and the same is also remarked of tartar emetic and other remedies. So changeable are the circumstances attendant on epidemics, so unequal the conditions of the system in different seasons, that we are often disappointed in our reasonable expectation of therapeutic operations. The truth of these remarks is well illustrated in the account of fever as it prevailed in some parts of Virginia in several successive years, by Dr. Lucas, and reported in Vol. 5th of the American Medical Recorder. "In 1818," says Dr. L., " from 5 to 10 grains tartar emetic, and from 16 to 20 grains of calomel, operated like a charm. In 1819, less than

from 25 to 40 grains of emetic tartar would not excite vomiting; and the doses of carthartics had to be increased in the same proportion. The case of a patient is stated who took nine drachms of calomel, with oil, salts and jalap, without any emetic, cathartic or silagogue effect. I never could tell," says the writer, "what became of the calomel."

It may be proper here to say, that calomel may be changed into corrosive sublimate in the stomach, if common salt or hydrocyanic acid be present. But it is not at all probable that much of the deleterious agency of pure calomel is assignable to this agency. Thousands take it every day, in moderate doses, with no bad effect, whose stomachs are as likely to contain the agents said to convert it into the bichloride, as are the stomachs of other persons. In truth, we are not of those who believe the stomach, in all cases, a mere chemical retort, in which precisely the same decompositions and recompositions occur that take place out of the body. On the contrary, we know and teach that the vital powers are capable of effecting changes that are impracticable by the same amount of chemical agency out of the body, and which cannot be accounted for apart from the vital energies. Oxides and salts are decomposed, and metallic matter deposited, under a temperature never exceeding 100 degrees Fahr., while the same compounds, out of the body, require, for decomposition, three or four times that amount of temperature.

In respect to the quantity of calomel that will exert a poisonous influence, we remark that this must, from necessity, be indefinite, inasmuch as different persons taking the same dose may, if rightly inspected, present much diversity of constitutional peculiarity, exemplified especially in the state of the stomach and bowels. Hence, the varied results from equal quantities of other active medicines, taken by the same person at different times.

The English writers, who have quoted some accounts of large doses of calomel, as employed in India and in this country, have yet to learn what is meant by large doses. Christison, well informed as he is, has been able to cite the use of this medicine to no greater extent than 840 grains in eight days, and he gets that fact from the American Jour. of Med. Sciences, Vol. 27. What will he say of tablespoonful doses every hour, until the patient held,

[ocr errors]

somewhere between the mouth and rectum, a pound of that article? That such doses have been given, is just as susceptible of proof as the fact that calomel is employed at all. I have known it prescribed in teaspoonful doses, as if it were calcined magnesia. And there is now remaining, in the hands of a gentleman in Lexington, the last of twelve powders, ordered for a cholera patient in 1833, which contains one ounce of calomel. Eleven of the same size were actually administered, but the patient died before the twelfth could be given. The reader who may desire a further acquaintance with facts in this relation, is referred to the American edition. of Pereria's Materia Medica, published in 1840, at Philadelphia.

That some persons who took enormous doses of calomel, during the prevalence of epidemic cholera, have survived the effects of the remedy, is not denied. But I know it to be as true, that thousands recovered who took no larger doses than ten grains of calomel, with one of opium, at suitable intervals. And the melancholy record, if it could be written out, would show that the mammoth doses have, in hundreds of cases, induced a total disorganization of the living system, deteriorated every solid fibre, as well as the whole circulating mass, and thus accelerated the fearful ravages of the epidemic.

I arrived in a town in the far West some years ago, just as the cholera had spent its force upon the populace. Of one thousand persons, one hundred and forty were cut off in about four weeks. From some of the medical attendants I learned enough to assure me that if the cholera had killed the people, calomel had also a share in producing the terrible results. A case was detailed, on the most undoubted authority, in which that medicine was forced into the victim without measure; and, although his death was a little delayed, the soft parts of the mouth, cheeks, etc., fell out a putrid mass, indicative of the horrid ravages of the disease and remedy conjoined. And this is only a specimen of hundreds of cases that might be gathered with ease in various sections of the country. Now I care not how these and other deleterious effects of calomel are brought about, so far as the facts are concerned. The how does not affect the reality. I may not be able to explain a fact, but that defect does not annihilate it. Who has ever seen cholera patients die in like horrid circumstances, under the most

simple treatment practiced in its early history? And how will any one attempt to explain the aggravation of circumstances, the disgusting scenes referred to, where the tablespoonful doses have been employed, apart from the baneful influence of the remedial agent mainly relied on?

It may not be irrelevant to notice, in this place, a discussion had in March, 1843, at a meeting of the Royal Medical and Chirurgical Society of London, on the agency of calomel in inducing that horrid sloughing of the mouth, cheeks, etc., that is sometimes the cause of death in young children. We agree with all the speakers, and believe that a disease of this kind may arise independently of mercurial medicine, while we are equally confident that it often has a mercurial origin. Such was the opinion of the president of the society, who quoted a case that had lately fallen under his notice, about which there could be no mistake.

We have seen cases of the kind referred to, that could be accounted for only by the morbific influence of calomel unwisely administered. It affords us much pleasure to learn from the discussion of this question, and from subsequent publications, that this disease is manageable by the liberal use of the chloride of potash. Dr. Hunt gives from one to two scruples of the salt in 12 hours, according to the age of the patient. The happy effects are visible in 48 hours, and the remedy will succeed if administered prior to the occurrence of serious exhaustion. The medicine is readily taken in sugar or syrup.

A very interesting, but not fatal, case of poisoning by calomel is reported in the American Journal of Medical Sciences for November, 1838. About one ounce was swallowed by a young female accidentally, in mistake for calcined magnesia; two hours elapsed before the error was detected, and yet no obvious effect had been produced, probably in part owing to the milk in which the article was mixed.

That the dose had partially paralyzed the stomach may be inferred from the fact that 30 grains of ipecacuanha had no effect, and a like dose was called for in order to set up vomiting. Under ordinary circumstances, 20 grains or less would have sickened her. A large bulk of calomel was discharged at once, entangled in a thick, ropy mass, made up of coagulated milk and other sub

stances, which rendered the calomel, to a certain extent, harmless. Gentle cathartics were given, and the girl recovered in three days without any untoward result. Had the same quantity of calomel been taken at bed time, and the fact been undetected till the next day, it is more than probable the issue would have been far less favorable.

There are some practitioners whose practice in the use of calomel, in diseases that do not quickly run their course, can hardly be exonerated from the charge of poisoning. For example: A physician devoted to calomel gives it in 40 or 60 grain doses, three times a day, or every two hours in a bilious pleurisy, as he calls it, expressly to set up free salivation. That is the desideratum, and is held to be synonymous with cure. But is the patient cured? Let us see. His tongue is protruded out of his mouth, the face greatly swollen, and the saliva streaming out at the rate of from a pint to a quart in 24 hours; but the patient is still swallowing the calomel powders (disguised with cochineal), two scruples at a dose, several times a day. You ask the doctor what this means, and he replies: "Oh, sir, the disease is broken; the man will be well in a few days; I am giving these small powders to purge what mercury he has taken out of the system. And what then? The system is sinking, the powers of life are fast ebbing, and in a week the man is in his grave.

[ocr errors]

Now if this use of calomel, after salivation has been established, be not a species of poisoning, I beg the executors of Noah Webster to get out a new edition of his dictionary to provide for such cases. Does any one inquire if the practice alluded to is not a very rare occurrence? Alas, for society! it is but too common in many portions of our country, and it is high time that it should be spoken of in the language of undissembled rebuke.

The remarks just made are intended mainly to arouse the attention of our profession to the rash, inconsiderate routine, and purely mechanical manner, in which calomel is dealt out to patients in the south and south western portion of our country. A devotion to theory should never blind any practitioner so effectually as to lead him to adopt a system, but because he has been taught that it is the true system. Nor should he allow himself to be so much enamored of a remedy as to fancy it cannot harm; yea, that without its aid he can do nothing in the management of diseases.

« SebelumnyaLanjutkan »