Hirschhorn and Feldman, with a third author, Ian A. Greaves, [22] followed their article on Mary Todd s tabes with another find from a letter written by Herndon: "Mr. Lincoln had an evacuation, a passage, about once a week, ate blue mass." [23] They found elemental mercury to be the active ingredient in blue mass, or blue pills, a medication Lincoln took over an extended period. They even had the blue pills recreated in the laboratory using a recipe from 1879 consisting of licorice root, rosewater, honey, and sugar, plus mercury and dead rose petals. Each pill contained approximately 65 grams of elemental mercury. The authors suggest that Lincoln may have been treated with the blue pills for melancholia, or hypochondriasis. Since syphilis sufferers were both depressed and had so many mysterious ailments that they often thought themselves to be hypochondriacs, the blue pills could have been prescribed for the "syphilis that hung to him" and melancholia and hypochondriasis at the same time.
In the "Blue Pills" article, Hirschhorn, Feldman, and Greaves find Lincoln's secrecy about the medication explained by the "opprobrium that would have been attached to the diagnosis of hypochondriasis in a person who aimed for high office." [24] Syphilis would have been very much more of a reason for circumspection, and a good reason to consult an out-of-town doctor. They suggest that Lincoln suffered from the neurobehavioral consequences of mercury intoxication-rage, for example. Herndon recalled that Lincoln looked like Lucifer when he was in an uncontrollable temper; he once shook a man until his teeth chattered. [25] Prone to moody silences, he was also observed talking "wild and incoherent nonsense" to himself. He had insomnia and headaches and worried about a tremor in his signature. An observer noted in 1863 that Lincoln "certainly is growing feeble. He wrote a note while I was present, and his hand trembled as I never saw it before, and he looked worn and haggard." [26] Lincoln had premonitions that he did not have long to live, and he feared madness. He took the little blue pills at least until 1861, a few months after his inauguration, and may have started them much earlier. Mary Todd tried them in December 1869. She had a quick and severe reaction and supposedly discontinued them immediately.
FOOTNOTES:
[22] Hirschhorn et al., "Blue Pills," 315-332.
[23] Hertz, 199.
[24] Hirschorn et al., "Blue Pills," 328.
[25] Hirschorn et al., "Blue Pills," 318.
"Hertz": Emanuel Hertz, The Hidden Lincoln: From the Letters and papers of William H. Herndon (New York:Viking, 1938)
"Blue Pills": Norbert Hirschorn, Robert G. Feldman, and Ian A. Greaves, "Abraham Lincoln's Blue Pills," Perspectives in Biology and Medicine 44, no. 3 (Summer 2001)
SOURCE: Deborah Hayden, POX: Genius, Madness, and the Mysteries of Syphilis, Basic Books, (2003), pp. 130-1.
Mercurial remedies were developed by the alchemist Paracelsus (1493-1541) in an attempt to find the "Elixir Vitae," a substance that would purify the body of all disease. Gold, which neither rusts nor tarnishes and is the color of the sun, source of life and energy, was amalgamated with mercury derived from blood-red colored cinnabar ore. Mercury, which had for centuries been used by the Arabs to treat leprosy and yaws, was first used in Europe for the treatment of syphilis in 1497. Hawkers of remedies, or quacksalvers (those who quacked about their salves), promising speedy and complete cures, became known as "quacks," the pejorative aspect deriving in particular from those itinerant vendors who pushed toxic mercury salve, known as quicksilver or quacksilver, for the treatment of syphilis. Reputable physicians also used mercury as their main treatment; this chemotherapy was still found to be "the most potent weapon of attack on syphilis” [2] well into the twentieth century.Mercury, a shiny element with the chemical symbol Hg, weighs 13.6 times as much as an equal volume of water. Iron, stone, and lead can float on its surface. Physicians who applied mercury-based ointments reported a lessening of their patients' pain and clearing of ulcers, but they tended to use such enormous quantities of the toxic metal that a price was paid in physical side effects, including new ulceration, dermatological eruptions, paralysis, shaking, anorexia, gastric distress, diarrhea, nausea, and rotting and loosening of teeth. The syphilitic overdosed with mercury would experience unquenchable thirst even while producing gushing saliva measured in pints and quarts, often while being encased in a steam box daily for a month. A hot iron applied to the skull to curtail salivation when absorbing vast quantities of mercury was one of the tortures these patients endured. Alchemists who distilled the quicksilver from heated cinnabar mixed the liquid metal with henna and herbs and heated it in a dry vessel over coals. The patient sat over a skillet under a cloak and inhaled the fumes.
Today, when dentists debate whether people are wise to have mercury amalgam fillings removed to prevent trace amounts of mercury escaping into the system, mercury applied to the point of extreme salivation seems unconscionable and illustrates how desperate the early practitioners were to find a cure for the hideous malady. How to kill the spirochete without killing the patient or causing damage as serious as that of the original illness was the challenge facing the first doctors treating syphilis. Oncologists today face a similar challenge with chemotherapy.
Mercury added diagnostic confusion when it produced symptoms that also mimicked other diseases or even the syphilis itself. How, for example, could a doctor distinguish the neurological damage of tertiary syphilis from the neurological damage of mercury poisoning? Or mercury paralysis from that of tabes? It was thought that mercury could cause deafness, but so could syphilis.
When the "little blue pill," also known as the small-dose gray powder pill, took the place of salve as a way of dispensing mercury in the middle of the eighteenth century, syphilitics had a treatment that was easily administered and allowed them to keep their mortifying secret. They no longer gleamed with a blue sheen or smelled like a fried potato. Mercury pills contained rosewater, honey, licorice, and conserve of rose petals. During many years of practice, Jonathan Hutchinson found "warm advocates" of treatment with the gray powder pill when the dose was kept continuous, frequent, and small. He recommended one grain of powder every six, four, three, or even two hours according to circumstances, and found that one pill four times a day was sufficient to clear up a chancre or a secondary eruption. He forbade fresh fruits and vegetables and fresh air during treatment. He specifically advised against treatment to the point of salivation except in extreme cases.
Hutchinson believed that those who had kept to long regimens of mercury were less apt than others to develop tertiary symptoms. Irregular and excessive mercurial treatment would jeopardize health, but there would be no loss to general health, Hutchinson promised, if mercury were employed in the way suggested over a long enough time. In cases where there were premonitory symptoms of late syphilis, Hutchinson even advocated a lifelong course. In the early stages, mercury destroyed the parasite, Hutchinson maintained, while in later years it was useful against inflammatory damage. John Stokes also testified to an extraordinary factor of safety combined with therapeutic effectiveness after treating some ten thousand patients who had taken hundreds of thousands of mercury rubs in his clinic.
If some thought that only mercury in abundance cured, the founder of homeopathy, Samuel Hahnemann, proposed the opposite: to cure syphilis with infinitesimal doses. His student Hartmann wrote: "In that stage of the Syphilitic disease, where the Chancre or the Bubo is yet existing, one single dose of the best mercurial preparation is sufficient to effect a permanent cure of the internal disease, together with the Chancre in the space of a fortnight." As to the dose, "I was formerly in the habit of using successfully 1,2 or 3 globules of the billionth degree, i.e., the 6th centesimal dilution, for the cure of Syphilis. The higher the degrees, however, even the decillionth (the 30th) acts more thoroughly, more speedily and more mildly. If more than one dose should be required, which is seldom the case, the lower degrees may be then employed." [3] Hahnemann claimed that he had never seen syphilis breaking out in the system when the chancre had been cured by homeopathy, unless there had been a previous overuse of mercury.
It is fitting that the remedies for early syphilis potent enough to kill spirochetes deep in the tissues were the heavy metals, mercury and bismuth, and a poison, arsenic. The other major syphilis medication, potassium iodide, used more for resolution of the gummy tumors of late syphilis and for advanced syphilis of the heart, was more benign, although patients complained of depression. Martin of Lubeck first administered an iodide for syphilis in 1821, using a burned sponge for the treatment of venereal ulcers of the throat. Wallace of Dublin used potassium salt in 1834.
FOOTNOTES:
[2] Burton Peter Thom, Syphilis (Philadelphia: Lea & Febiger, 1922), 202.
[3] N.K. Banerjee, Homeopathjy in the Treatment of Gonorrhea & Syphilis (Delhi: B. Jain, 1995), 158.
SOURCE: Deborah Hayden, POX: Genius, Madness, and the Mysteries of Syphilis, Basic Books, (2003), pp. 45-8.