By John Vallee, MD
With the current discussions in Washington around the reduction in staff at the Department of Health and Human Services and the impact this will have at the FDA, it got me thinking about the artifacts we have at the Museum of Medical History showing all the different lotions, potions, and various medical devices — especially the purported medications that have been used in the past without much evidence of efficacy. In addition to the four cases named “Patent Medicine, Quackery, Laxatives, and Pharmacy” holding these items, there is another entire case devoted to materials that cause “bleeding, puking, purging, and cupping.”
These medications and treatments were allowed to flourish and be actively promoted in the years prior to the passage of the Pure Food and Drug Act in 1906. Created to ensure public safety, the Pure Food and Drug Act laid the foundation for the establishment of the Food and Drug Administration in 1930 and addressed consumers’ concerns over the way food was processed and the availability of drugs that were thought to be unsafe and dangerous. Despite some errors through the years, there is no doubt that things are better since the FDA has been in existence.
One of the most common ingredients in these “medications” was the element —and known toxin — mercury.
Mercury is the 80th element in the periodic table and has long been used in a variety of industrial and commercial uses such as gold and silver mining, scientific instruments, electrical switches, and even in the of making felt hats. Mercury causes the felt material to stiffen and hold its shape and led to Alice’s “Mad Hatter” — a reference to the neurological symptoms and emotional instability experienced by workers who were exposed to mercury vapors while processing fur felt — in Lewis Carroll's novel.
Mercury-based tinctures at the Museum of Medical History.
Mercury’s use in medicine can be traced from its use in ancient China through ancient Rome, then to a 400-year run as the “go to” treatment of syphilis from the 15th century until the early 1900s when it was finally replaced. The main problem with mercury is that it is very toxic and patients would often die of mercury poisoning, thus making the “cure” worse than the disease.
Early History: Ancient China and Ancient Rome
As early as the Sheng Dynasty (1600-1064 BCE) in ancient China, there was mention of cinnabar (mercury sulfide) as a medicinal substance. Apparently, it was thought to be a kind of “longevity pill” and Records of the Grand Historian, available in our Museum, indicate it was used by Qin Shi Huang (259-210 BCE), the first emperor of the unified China. Cinnabar was found in high concentration in the soil around the emperor's tomb. Seeing as he only lived to age 49 and showed evidence of mercury poisoning, it is clear that the longevity pill didn't work.
The Ancient Greeks and Romans also used mercury. It can be imagined that they were fascinated by its properties of appearing both as a liquid and a solid. It was described by Theophrastus (371-287 BCE) in Greece where he explained how to extract the material for use in skin conditions. Later, two Roman physicians, Pliny the Elder (77-79 CE) and Galen (129-210 CE), used mercury in their medical practices to treat skin conditions and as a whitening agent. Pliny the Elder discussed it at some length in his writings, titled Natural History. Apparently, if you can put up with the long term toxicity, mercury can lighten your skin, hide freckles, and reduce age spots and blemishes.
Treatment for Syphilis
The most lasting story of the use of mercury in medicine was in its supposed value as a treatment for syphilis. Syphilis was a major epidemic in Europe beginning in the late 15th century and over the following 400 years. During this time, the treatment of choice was mercury. The first documented use came from physician Giorgio Sommariva of Verona, who applied mercury ointment to syphilitic sores in 1496.
Mercury has antimicrobial properties and can kill the spirochetes causing syphilis by disrupting cell membranes and denaturing proteins. However, it has limited efficacy and is toxic as it accumulates in the body as a heavy metal. It appeared to affect early-stage skin lesions but generally resulted in an incomplete cure, with mercury itself causing negative side effects and additional health issues.
Various treatments containing mercury were administered in different forms including ointments, fumigation, oral consumption, and direct injections. There was a saying, “A night with Venus, a lifetime with mercury.” Mercury had its critics along the way, but wasn't replaced as the first-line treatment for syphilis until 1910 by Asphenamine (also known as Salvarsan), which was developed by the brilliant Paul Ehrlich and his team in 1910.
This was one of the first antibiotics that could treat infectious diseases without seriously harming the human host. The compound Salvarsan was the 606th compound used by Ehrlich and his group. It was still somewhat toxic, since it was made from arsenic, but was much safer and more effective than mercury. Salvarson was replaced in 1940 by the antibiotic penicillin, which has a much better safety profile, is inherently more stable, and is still our treatment of choice today.
Mercury was the go-to treatment for syphilis for over 400 years and was used in the form of calomel as a way to balance the four humors.
Mercury Use in U.S. History
There is a notable connection between mercury and U.S. history as mercury was included in the medical kit of Benjamin Rush, a signer of the Declaration of Independence and a distinguished physician from New York. Dr. Rush, like many physicians for centuries, believed in the Hippocratic theory of the four humors (phlegm, blood, black bile, and yellow bile) which needed to be balanced to maintain health. He used mercury in the form of calomel to induce vomiting and diarrhea as a way of balancing the four humors and as a method of curing a host of diseases.
The yellow fever epidemic of 1793 was particularly devastating, killing about 10% of the inhabitants of Philadelphia. Although mercury is not effective in treating yellow fever or typhoid (where it was all so used), it was used as a treatment in that era along with bloodletting and had its proponents.
As mentioned above, calomel (mercurous chloride) was an effective bowel stimulant. When Merriweather Lewis and William Clark were asked by Thomas Jefferson to explore the Louisiana purchase in 1804, Lewis called upon his former teacher Benjamin Rush to supply the group’s medical kit. Rush naturally provided his famous Dr. Rush’s bilious pills. The pills, also known as “Thunder Clappers,” were used as a purging medication for the expedition members. They could be used for constipation but also had purported value in other ailments such as stomach aches and abdominal distress. Because the pills contained the heavy metal mercury, historians have a very accurate record of the Lewis and Clark Trail through their bowel movements.
Twentieth Century Use
Mercury had a resurgence in use during the 1900s in less toxic forms known as mercurochrome and merthiolate. Many of the doctor bags on display in the museum had mercurochrome inside ready to be used on skin to clean a wound. It was considered one of the standard contents and thought to be quite useful, with its bright orange color staining the wound, the surrounding skin, and sometimes clothing.
Merthiolate (also known as Thimerosal) has been used in some vaccine preparations. This practice has given rise to serious discussions about the safety of some vaccines. Apparently, in multidose vials it has its place as an effective preservative and as prevention against contamination. Although numerous studies have shown that it is safe, no childhood vaccines nor vaccines for use in pregnancy currently contain Thimerosal. Today, only a small number of medical products have even a trace of mercury.
The final death knell for mercury came in 1998 when the FDA finally deemed it not generally recommended as safe or effective (NGRASE). This ended mercury’s long reign in the category of quackery.
A good source for more about mercury’s history is Quackery: A Brief History of the Worst Ways to Cure Everything, by Lydia Kang and Nate Pederson. Come to the Museum of Medical History, located at the SSVMS office at 5380 Elvas Avenue, Sacramento, to see this and other fascinating forms of medical quackery!
