II32 CHEMOTHERAPY OF BACTERIAL DISEASES 



to fluorescein, and sometimes mistaken for blood; the urine may be red in color. The 

 patient may complain of nausea and vomit, which may be colored red. A rather 

 severe chill is produced, lasting from ten minutes to an hour but usually not more 

 than twenty minutes, and the temperature is increased by i°-3° with increased pulse 

 rate. As a general rule these reactions subside in twelve to twenty-four hours. I have 

 never seen nor heard of a fatal acute reaction of this kind, but several individuals have 

 succumbed to the later toxic effects of mercurochrome. I know of two fatalities due 

 to acute nephritis with almost total suppression of urine. Mercurochrome should not 

 be used promiscuously or too freely and especially if nephritis is present. 



MECHANISM OF THE CURATIVE ACTIVITY OF THE MERCURIALS IN BACTERIAL DISEASES 



Unfortunately, but very little has been determined regarding the mechanism of 

 the antibacterial properties in vivo of the compounds of mercury, gold, silver, copper, 

 arsenic, creosote, etc., discussed in this chapter. Whatever direct bactericidal effects 

 they may have in vivo would appear to be due to the metallic ions after dissociation 

 of the compounds. Whether or not the mechanism of curative activity of the mer- 

 curials is the same in bacterial diseases as in syphilis cannot be stated. But in view 

 of the well established curative activity of these substances in syphilis and the almost 

 total absence of curative influence in chronic bacterial diseases, it would appear that 

 the ions of mercury have a greater combining affinity for Sp. pallida or in some other 

 way are most toxic for these parasites. 



It is commonly stated that mercury cures syphilis by increasing antibody pro- 

 duction, but I have never been able to elicit direct evidence of any such mechanism, 

 and surely such could have no relation to the rapid improvement of acute bacterial 

 infections following intravenous injections of mercurochrome. It may be, however, as 

 discussed above in relation to the chemotherapy of tuberculosis, that various com- 

 pounds of mercury, gold, arsenic, etc., produce focal reactions of hyperemia with 

 serous and cellular exudation and resulting in increased fibrosis, but the mechanism of 

 these effects, which are so similar to the focal tuberculin reaction in tuberculosis, has 

 never been worked out. 



It has also been frequently suggested that the acute mercurochrome reaction and 

 its curative effects in acute bacterial infections are due to a non-specific protein reaction 

 ascribed to the effects of a new compound of mercury with the plasma proteins. It is 

 true that the reaction bears some resemblance to the effects produced by the intra- 

 venous injection of vaccines, peptones, and other foreign proteins but the mercuro- 

 chrome reaction in my opinion is a colloidal phenomenon and similar in its mechanism 

 to the anaphylactoid reactions produced by the intravenous injection of a variety of 

 colloidal preparations of the heavy metals, arsenic, various proteins, etc. 



But in truth we do not know how the colloidal reactions are produced nor how 

 bacteria in the blood are destroyed by the mercurials and other compounds mentioned 

 in this chapter; there are still very obscure problems offering great difficulties in 

 elucidation but warranting and urgently demanding investigation for the purpose of 

 placing the chemotherapy of the bacterial diseases upon a more scientific basis and 

 removing it from the realm of its present state of almost pure empiricism. 



