Untoward Effects of Mercury.—When rlirre rx'sts in the individual treated an Inn= .al sensitiveness to mercury or the drug le giv,u too long or in excessive qPtan•ties, symptoms appear that are quite pathognomonic. There is, at first, d:sag-reeable metallic taste, the breath is fcetid,—the fi.nter of dead tissue,—the gums are sensitive, and when the jaws are forcibly closed slight pain is experi enced. At the same time the saliva be comes more free than usual. If as soon as these symptoms appear the adminis tration of the drug is not stopped, as should always be the case, the gums be come spongy and bleed easily; the tongue swells, and the flow of saliva becomes ex cessive,—ptyalism. If the gums be exam ined, a dark line will be found. at their junction with the teeth. The parotid and maxillary glands are usually en larged and tender, and there may be slight fever.
Catharsis and mild ptyalism followed to doses of the yellow subsul phatc of mercury (turpeth mineral), given to produce vomiting in a child of three years. Bradford Woodbridge (Occi dental Med. Times, Mar., '91).
Case in which ptyalism was produced by the local application of black wash. T. J. Walker (Brit. Med. Jour., Nov. 2S, '91).
Case of salivation in a child from less than 2 grains of calomel. Krotoszyner (Occidental Med. Times, Mar., '96).
Persistence in the use of mercury after these manifestations is followed by local destructive changes. Ulceration of the mucous membrane, soon invading the deeper tissues, looseness and loss of the teeth, necrosis of the jaw-bones, copious Illemorrhages occurring through ulcera tion of the vascular coats, follow in more or less rapid succession, and the patient dies of exhaustion. It is rare that such a result occurs nowadays. The eases of mercurial poisoning usually met with are usually due to insufficient instruc tions to the patient, who continues to use the remedy without consulting his physician.
In some cases the skin is first to show the mercurial manifestations, an erup tion resembling that of scarlatina being that most frequently observed. Great suffering is sometimes entailed, as shown Cameseasse's case given below.
Case of a man,45 years of age, in whom mercurial inunctions were followed by severe ptyalism, painful tongue, loosened teeth, fietid breath, a. papular and pus tular eruption accompanied by intense itching, and a purpuraccous desquaina t ion. The temperature Iva.,; raised to 102° F., and there were produced also loss of appetite, tremor, albuminuria, and other symptoms. The patient finally recovered under proper treatment. He exhibited, some time later, the same train of symp toms after the administration internally of 10 grains of calomel divided in four doses. The eruption now was of a mili ary and searlatiniforin character. The primary symptoms were chills and fever at night. Robinson (Med. Analectic and Epit., Aug., '90).
instance of erythema scarlatinoides following the application of mercurial ointment to the pubic region in which diagnor;is of scarlatina was made by a physician. Within a week there followed
abundant, desquaination from the entire body, especially profuse on the hands and feet. At no time was there an eleva tion of temperature nor was the throat implicated. Fordyce (Jour. Cut. and Dis., Dee., '95).
Case of an old woman, suffering from irregular heart-action re.sulting from a long-stauding mitral insufficiency who received five doses of 2/, grain of calomel at three-hour intervals on alternate days for a week. Patient was upon a milk diet, and received a simple clyster each morning,. Aliodernte purgation and eon siderable diuresis ensued, with consequent. diminution of anasarea and dyspmea. -Upon the day following the. first day's use of the drug there was noticed Fl slight burning over the entire body, but espe cially over the face, neck, and hands. The second day rNlitess appeared. At the end of the week the burning S atrocious, the entire surface of the skin was scarlet, red, violet in places, swelled, and thickened. '1'he hairy scalp rema ined -uncolored. The palms and soles were less colored than the other surfaces, but yet were red. In a few- days spontaneous cure appeared, but accompanied by an abundant and extraordinary desquama lion, 'which extended to the hairy scalp and to the timeons surfaces. First, large surfaces were del aehed, then small scales, and finally a whitish powder. proc ess lasted fifteen days. althom211 the mu eons surfaces were healed at an earlier period. There was not any elevation of temperature. nor did the redne,s of the mouth resemble a mercurial stomatitis. Camescasse (Rull. de Th6r., le by., p. 20, .9S).
Case of a woman who NV11 confined Alarch ltith. -Wheii she was seen first— about ten days later—there was evi dence of septieiemia, and she was accord ingly given a douche consisting of one gallon of a 1 to 4000 solution of mercury biehloride. \\lien seen two or three days later. there \vas excessive ptyalisin, with swelling of the gums. -Mercury had not been ri,:ed 111 any other form, and there hod been perfect drainage. T. R. -Mansfield (Jour. Amer. :Med. Asst,e., July 14, 1900).
Case of localized gangrene following an extremely painful intramuscular in jection of the bromide of mercury. Brocci has reported a -dittilar result after a painful injection of the bromide. and Lesser had gangrene oecur after two in jections of mercury bichloride, which were followed by prolme bleeding. The author expresses the view of Broeq that the gangrene was due to a direct injury of the nerve. while Lesser ascribes the condition to the injury of a large blood vessel. l'Itiiger (.Archiv Derm. Syph., lx, p. 425, mo2).
-Untoward symptoms of mercurial poi soning do not only manifest themselves as a result of the therapeutic use of mer cury; they are often brought about by the handling of mercury ns an occupa tion or the inhalation of its fumes. This is termed "chronic mercurial poisoning."