Triturations of mercury with sugar, however, were already well known in England, "mercurius saccharatus" being found at most of the shops.

Later, Hahnemann proposed that a very large number of drugs should be prepared by this process, and selected milk sugar as the agent to be employed in the trituration; first, because it is supposed to be inert medicinally, and second, because its particles are hard and gritty, and well adapted to the comminution of other substances. Curiously, none of the standard pharmacopoeias of the time adopted this method; and, at present, if we desire an officinal preparation of metallic mercury in the form of powder, we have offered us the Hydrargyrum cum creta, made by triturating mercury with prepared chalk. This substance is an almost impalpable powder without grit, and experience has shown that it is not wholly satisfactory as a triturant. Various amendments to the process have been proposed - the addition of resin, by Stewart (1843), of honey, by Squibb (1857), and finally, "W. E. Bibby (1876) has suggested a method which enables a pharmacist to prepare this medicament without the expenditure of much time, by substituting sugar of milk for about one-fifth of the chalk, which greatly facilitates the fine division of the metal" (Nat. Disp., 1st Ed., p. 728).

* Not for its mechanical effects, as is sometimes done nowadays, but medicinally. ++ A new and easy method of giving mercury to those affected with the venereal disease, etc., translated from the Latin by Wm.Saunders, M.D., Physician to Guy's Hospital London. 1772. Plenck states (p. 30) that he obtained the idea of trituration from Philippus Ambrosius Marherr. rations were well known to the Arabian physicians of the 18th century. The writings of Ibn el Beithar contain frequent references to them.

Whatever the reason, whether from differences in the processes, or dishonesty in the manufacture, the hydrarg. c. creta of the shops is far from uniform, and is regarded by many as a very unreliable preparation. A few years ago the writer gave special attention to this subject, and embodied the results of his investigations in a short paper, read before the New york Academy of Medicine, and subsequently published (143, Dec. 1,'77). The subject of the paper was a comparison of milk sugar triturations of mercury and its salts with the ordinary officinal preparations of this drug. The following is extracted from that paper:

The first chosen for examination was the lx trituration of mercurius vivus, and it was compared very naturally with our own analogous preparation, the hydrarg. c. creta. Examined under the microscope the mercury in the former was found to be in a state of extremely minute subdivision, the majority of the separate globules being smaller than red blood-corpuscles, and many of them so small as to be endowed with Brunonian movement.

"Five samples of hydrarg. c. creta, obtained from Broadway drug stores, were then examined. These were found to vary greatly in their gross appearances, and likewise under the microscope. In some there appeared to be a notably larger proportion of mercury than in others, and in all of them the metallic globules were very much larger in size (average) than those in the merc. viv.

"Now when we administer mercury for its specific effect upon the blood or upon particular organs, the first essential is that it shall be absorbed. If the drug is in solution there is of course little difficulty about the mat-r, but if given in a solid form, it must either be capable of solution by the fluids of the stomach, or else its particles must be sufficiently minute to permit of their direct absorption as solids. The fact of the absorption of solids, at one time deemed impossible, has now been so thoroughly demonstrated, and especially as regards mercury, that we are prepared to understand how minute subdivision will facilitate absorption, when larger particles would pass the bowels without effect, or simply produce local effects, varying with the nature of the drug employed. We should therefore expect that, a given quantity of drug being used, the promptness of its specific effects would vary inversely with the size of the particles of which it is composed. If we submit this rational conclusion to the test of clinical experience in the cases of hydrarg. c. creta and mercur. viv., we will find it easily verifiable. The latter, given in doses containing the same amount of mercury as the former, will produce the more prompt and decided effects.

"Turning- from metallic mercury to its salts, we find an inviting field for exploration. The mercurous preparations are almost invariably given in the solid state, while the mercuric are administered both in the solid form and in solution.

"We are all of us aware that a single grain of calomel well rubbed up with sugar and given in, say, twenty divided but frequently repeated doses, will often produce the specific effects of the drug, while a single dose of twenty grains will as frequently fail to do so. Passing calomel, then, we come to another mercurous preparation, namely the protoiodide. This salt, in its condition of ordinary medicinal purity, was found, upon microscopical examination, to consist of comparatively large-sized masses composed of apparently smaller granules. Moderate pressure on the covering glass was sufficient to disintegrate these masses and to resolve them into much smaller particles, not exhibiting crystalline structure, and averaging about the size of red blood-corpuscles, or a little less. A gelatine-coated protoiodide pill was found to contain the drug in the same fine granular condition. Sugar-coated pills of French and American manufacture were also examined, and the mercury found to be in quite small particles. In all of these specimens the "drug was in a very minute state of subdivision, and the greater part of it doubtless capable of direct absorption without previous solution. This is of importance when we consider that this salt is but sparingly soluble.

"The first decimal (lx) milk-sugar trituration of the protoiodide was next examined. In this the salt appeared to the naked eye to be very uniformly distributed throughout the powder, and upon microscopical examination was found to consist of extremely minute particles, of decidedly smaller size than in the previously examined specimens. It is to be expected, therefore, that the protoiodide trituration will prove, ceteris paribus, more active than the pill, and such we have found it.

"Turning now to the mercuric preparations, we find the bichloride and biniodide most in use. For obvious reasons, triturations of the former were not examined microscopically. Gelatine- and sugar-coated pills of the biniodide, however, were carefully investigated. In the gelatine-coated pills we found the salt displayed as beautifully perfect crystals of varying size. In the sugar-coated preparations the drug was in small granular masses, held together by some not very soluble substance. In the first centesimal (2x) trituration the biniodide was apparently well distributed through the powder, and upon examination was found in particles of very much smaller average size than in any of the other preparations. The biniodide of mercury is exceedingly insoluble, and there can be no question but that its absorption is therefore very much facilitated by minute subdivision. It is, moreover, a powerful irritant, and one would naturally expect that particles too large for direct absorption, or slow of solution, would be apt to produce more or less gastric distress before they are finally disposed of. That the iodides of mercury frequently produce gas-tralgia and diarrhoea is well known, and personally we believe that this is due to the local irritation produced by them, and not to any elective action of the drug. Since we have used the triturations, however, in preference to the ordinary pills, patients more rarely complain of disagreeable sensations. We have further been enabled to materially reduce the size of the dose, in order to obtain the desired effect. In other words, a larger proportion of the drug is utilized for specific purposes, while but a small amount mains to give rise to local irritation."

The British Pharmacopoeia has adopted a 1/10 milk-sugar trituration of elaterium, and the pepsine manufacturers throughout this country usually supply their product in this form, and not pure pepsine as some may suppose.

I have nothing to add to this except that I continue to use triturations of mercury and other substances with increasing satisfaction. Beside those mentioned I employ calomel, cyanide of mercury, black oxide of mercury, and corrosive sublimate in this form.