The metal taken in bulk into the stomach has been considered non-poisonous, and, probably, when perfectly pure, it is so; we have, however, the case of a girl who swallowed 41⁄2 ozs. by weight of the liquid metal, for the purpose of procuring abortion—this it did not effect; but, in a few days, she suffered from a trembling and shaking of the body and loss of muscular power. These symptoms continued for two months, but there was no salivation and no blue marks on the gums. This case is a rare one, and a pound or more has been taken without injury.
§ 838. Absorption of Mercury by the Skin.—Mercury in a finely divided form, rubbed into the skin, is absorbed, and all the effects of mercurialism result. This method of administering mercury for medicinal purposes has long been in use, but, when the inunction is excessive, death may occur. Thus, Leiblinger records a case in which three persons were found dead in bed; the day before they had rubbed into the body, for the purpose of curing the itch, a salve containing 270 grms. of mercury finely divided.
It is difficult to say in what proportion workers in mercury, such as water-gilders, &c., suffer. According to Hirt, not only do 1·5 to 2·1 per cent. of the workmen employed in smelting mercury ores suffer acutely, but as high a proportion as 8·7 per cent. are slightly affected.
§ 839. Symptoms of Poisoning by Mercury Vapour.—The symptoms of poisoning by mercury vapour, or by the finely divided metal, are the same as those which arise from the corrosive salts, with the exception of the local action. In mild cases there is pallor, languor, and sore mouth (from slightly inflamed gums), fœtid breath, and disorder of the digestive organs. If the action is more intense, there is an inflammation of the gums and, indeed, of the whole mouth, and salivation, which is sometimes so profuse that as much as two gallons of saliva have been secreted daily. The saliva is alkaline, has a bad odour, and its specific gravity in the early stages is increased, but ultimately becomes normal; the gums are raised into slight swellings, which gradually enlarge and coalesce. The teeth that are already carious, decay more rapidly; they become loose, and some may be shed; the inflammatory action may extend to the jaw, and necrosis of portions of the bone is no unusual occurrence. On recovery, the cheeks sometimes form adhesions with the gums, and cicatrices always mark the loss of substance which such an affection entails. With the stomatitis there are disturbances of the gastro-intestinal tract—nausea and vomiting, pain in the stomach, and diarrhœa alternating with constipation. Conjunctivitis is very common, both in man and animals, from exposure to mercury vapours. The further action of the metal is shown in its profound effects on the nervous system. The patient is changed in his disposition, he is excitable, nervous, or torpid; there are sleeplessness and bad dreams, at the same time headache, noises in the ears, giddiness, faintings, &c.
§ 840. Mercurial Tremor.—Mercurial tremor[917] may follow, or accompany the above state, or it may be the chief and most prominent effect. It specially affects the arms, partly withdrawing the muscles from the control of the will, so that a person affected with mercurial tremor is incapacitated for following any occupation, especially those requiring a delicate and steady touch. In cases seriously affected, the tremor spreads gradually to the feet and legs, and finally the whole body may be invaded. The patient is no longer master of his muscles—the muscular system is in anarchy, each muscle aimlessly contracting and relaxing independently of the rest—the movement of the legs becomes uncertain, the speech stuttering, the facial expressions are even distorted into grimaces, and the sufferer sinks into a piteous state of helplessness. The convulsive movements generally cease during sleep. The tremors are accompanied by interference with the functions of other organs: the respiration is weakened and difficult; dyspnœa, or an asthmatic condition, results; the pulse is small and slow; paresis, deepening into paralysis of the extremities, or of a group of muscles, follows; and, lastly, if the condition is not alleviated, the patient becomes much emaciated and sinks from exhaustion. Pregnant women are liable to abortion, and the living infants of women suffering from tremor have also exhibited tremor of the limbs.
[917] A case of mercurial tremor (in Bericht. des K. K. Allgem. Krankenhauses zu Wien im Jahre 1872, Wien, 1873) is interesting, as showing the influence of pregnancy. A woman, twenty years of age, employed in making barometers, had, in 1869, mercurial tremor and salivation. During a three months’ pregnancy the tremor ceased, but again appeared after she had aborted. She again became pregnant, and the tremor ceased until after her confinement in November 1871. The tremor was so violent that the patient could not walk; she also had stomatitis; but ultimately, by treatment with galvanism and other remedies, she recovered.
In the case of the “mass poisoning” on board the “Triumph,” it has been mentioned that several of the sailors became consumptive, and the same effect has been noticed among all workers in the metal; it is now, indeed, an accepted fact that the cachexia induced by mercurialismus produces a weak habit of body specially liable to the tuberculous infection.