medicine
Calomel
04/11/2009 09:15
The harmful effects of mercury weren’t unknown to early doctors. Along with bloodletting, calomel was often used as a “depletive,” since medical theories of the time held that first inflammation, and later “excitement of the blood” was the cause of most illness. Early in the nineteenth century, the general public also began to understand the danger of mercurial medicines, and to distrust physicians who relied on them. This distrust was fueled by critics in the popular press like William Cobbett, who quipped that Benjamin Rush’s heroic practices were “one of the great discoveries…which have contributed to the depopulation of the earth.” Another source of testimony against the use of calomel came from “sectarians,” alternative medical practitioners who sprang up to challenge traditional doctors in the early nineteenth century. Thomsonian botanical healers, hydropaths and homeopaths took advantage of warnings in medical texts and horror stories of patients injured or killed by heroic treatment, to suggest that the traditional doctors were doing more harm than good.
Traditional doctors in the early 1800s were very concerned about their profession. While the previous generation had been trained by “preceptors” in a system very much like traditional apprenticeship, a series of medical schools established in the decades surrounding the turn of the century began sending M.D.s into the field. This new generation was eager to make its mark, and aspired to the respect and status afforded lawyers and ministers, the other professional men in their communities. Doctors formed associations, lobbied for standards and licensing laws, and fought back against the quacks and heretics who challenged the efficacy of their methods.
The Boston Medical and Surgical Journal (BMSJ) was one of the earliest American medical publications, and it circulated widely. Beginning in 1828, the BMSJ offered doctors from New England, New York, the western territories, and as far away as New Orleans a forum for sharing cases, and a place to read about medical advances, the ongoing battle against sectarian “quackery,” and the struggle to establish medicine as a distinguished and respected profession. The editors of the BMSJ were keenly aware of the public’s distrust of heroic treatment, and especially of calomel. But rather than addressing these concerns open-mindedly, they adopted a policy of deriding and alienating anyone who spoke ill of their panacea. Their rejection and demonization of skeptics and dissenters damaged the respect and public credibility they were so anxious to gain. The continued use of calomel and the BMSJ’s dogged defense of mercurial medicine from the late 1820s to the early 1840s did a lot to convince the public that American medicine wasn’t ready to be taken seriously.
It’s clear from the pages of even the earliest issues of the BMSJ that doctors were aware of the dangers of calomel, and the specific symptoms presented by mercury poisoning. In a March 1828 letter on a case involving a woman with “Apoplexy,” the author says he prescribed a scruple (20 grains) of calomel for four days, until the patient’s “mouth became very painful, much swelled and inflamed from the calomel.” An Ohio doctor writes a letter suggesting a solution of water and “tartarate of antimony for checking mercurial salivation.” Another article quotes the City Physician of Boston, declaring that in a recent smallpox outbreak, “Calomel was given only a few times…but its administration, it was conceived, was followed by bad consequences, inasmuch as the ptyalism, peculiar to the disease, was very much increased, the breath more offensive, and the exhalations intolerable even to the patient himself.”
In late 1829, a correspondent calls BMSJ readers’ attention to an article on “Gangrenous Erosion of the Face” in the American Journal of the Medical Sciences. The writer describes a case of his own, in which a four-year old girl was treated with calomel for typhoid fever. Soreness in her mouth led quickly to gangrene that advanced until it covered the girl’s cheek from eyelid to ear, and two thirds of the lips and chin. Her teeth fell out, and “twelve days from the first appearance of the danger, the little patient died, completely exhausted.”
A month later, Dr. R. A. Merriam describes several cases. In the first, a ten-year old girl was treated, with eight doses of calomel over the course of three weeks. When Merriam first saw her, she had swelling and soreness in her mouth that the other doctor had called canker. This progressed “uninterruptedly to gangrene and sphacelation [morbidity] of both lips, and the greater part of the right cheek, before her death, and left such a hideous spectacle…as made it desirable she might not survive. Our wishes were realized.” In another case, a forty-year old man “to whom much mercury had been given, and pursued for a considerable time, in small doses, and even after profuse ptyalism had been established…His mouth and face swelled; he could not distinctly articulate for several months; his teeth fell out; and portions of his lower jaw, including the sockets of the teeth, came out. At the end of nine months he died…” In both cases, Dr. Merriam is careful to note that the treatments leading to their deaths had been prescribed by someone else before he’d first seen the patients.
Merriam refers to Dr. Samuel Jackson’s July 1827 article on “Gangrenopsis” in the Philadelphia Medical Recorder, in which Jackson “more than hinted” mercury was to blame. Merriam agrees that “it cannot be disguised, that the action of this most powerful weapon against disease, produces sometimes very disastrous effects.” He notices that Dr. Webber “has not even appeared to suspect” mercury, even though it was probably prescribed in all the cases he cited. Merriam sees no reason to suppose that a new disease has been discovered, as Brown suggests. While other sources of infection can cause facial gangrene, he’s “satisfied that the gangrenous erosion was caused by the operation of mercury” in the cases cited.
A month later, Charles Hubbard of Winthrop Maine writes to dispute Brown’s suggestion that mercury causes “gangrenous erosion” of the face. He relates the case of a four-year old boy he treated for “autumnal remittent fever.” Hubbard says he gave the boy calomel several times, in combination with other drugs, “to evacuate the stomach and bowels.” There was “no salivation, soreness of the gums, or mercurial fetor of the breath, during his illness,” Hubbard says. But “in the tenth day of the fever, the frightful gangrene made its appearance. We then observed a very disagreeable fetor…At the time of dissolution, which happened on the 35th day of his sickness…the ulcer had spread to within an inch of the eye above, and was on a level with the base of the lower jaw…The affected parts had a jet black appearance, with an indescribably bad fetor.”
“Is this a disease sui generis?” Hubbard demands. “It does not arise in consequence of general debility…Nor can it be the production of mercury.” This is clearly the point Hubbard wants to make, but he has nothing to hang his conclusion on except this declaration. Hubbard argues that Jackson didn’t say mercury had definitely been used in all his cases, and that where it was administered, “it had not produced its constitutional effects,” meaning it had purged, but not salivated the patients. Hubbard’s distinction suggests that he secretly considers that ptyalism is required for gangrene to set in. But he damages his argument by admitting in closing that he’s only ever seen one other case, while he was a student, and he didn’t take any notes.
In the letter immediately following Hubbard’s, E.G. Davis of Boston admits the connection between mercury and facial disease, and proposes a cure. Davis’ patient was a twenty-year old woman, who’d taken unknown medication from a previous doctor. Based on her symptoms and the “mercurial fetor” of her breath, Davis concluded “excessive use of mercurials.” The woman’s “gums, submaxillary glands, cheeks and tongue were greatly swollen; the latter was covered with a dense hard, black secretion; the jaws could scare be separated, the utterance was inarticulate; the flow of saliva was constant.” Davis believed he cured her with a blister applied to the back of her neck. The BMSJ editors’ willingness to publish both sides of the argument, at this point, suggests either a disagreement among the editors or that mercury was not yet the political issue it would soon become.
...to be continued.
