The course of the poisoning is generally more rapid when it has resulted from the taking of mercury internally as a medicine than when inhaled by workers in the metal, e.g., a patient suffering from mercurial tremor shown to the Medical Society by Mr. Spencer Watson in 1872, had resisted for seven years the influence of the fumes of mercury; and then succumbed, exhibiting the usual symptoms. Idiosyncrasy plays a considerable rôle; some persons (and especially those whose kidneys are diseased) bear small doses of mercury ill, and are readily salivated or affected; this is evidently due to imperfect elimination.
§ 841. Mercuric Methide, Hg(CH3)2.—This compound is obtained by the action of methyl iodide on sodium amalgam in the presence of acetic ether. It is a dense, stable liquid, of highly poisonous properties. In 1865, mercuric methide, in course of preparation in a London laboratory, caused two cases of very serious slow poisoning.[918] One was that of a German, aged 30, who was engaged in preparing this compound for three months, and during this time his sight and hearing became impaired; he was very weak, his gums were sore, and he was ultimately admitted into St. Bartholomew’s Hospital, February 3rd, 1865. His urine was found to be albuminous, and his mental faculties very torpid. On the 9th he became noisy, and had to be put under mechanical restraint. On the 10th he was semi-comatose, but there was no paralysis; his breath was very offensive, his pupils dilated; at intervals he raised himself and uttered incoherent howls. There was neither sensation nor motion in the left leg, which was extended rigidly; the knee and the foot were turned slightly inward. On the 14th he died insensible.
[918] St. Barth. Hosp. Reports, vol. i., 1866, p. 141.
The only appearance of note seen at the autopsy was a congestion of the grey matter in the brain; the kidneys and liver were also congested, and there were ecchymoses in the kidneys.
The second case—a young man, aged 23, working in the same laboratory—was admitted into the hospital, March 28th, 1865. In the previous January he had been exposed to the vapour of mercuric methide for about a fortnight; during the illness of the other assistant he felt ill and weak, and complained of soreness of the gums and looseness of the teeth. He had also dimness of vision, pain and redness of the eyes, giddiness, nausea and vomiting, the ejected matters being greenish and watery. At the beginning of March his sight and taste became imperfect—all things tasted alike; his tongue was numb and his gums sore, he was also salivated slightly. A week before admission he lost his hearing, and first his hands and then his feet became numb; on admission his breath was very offensive, his pupils dilated; the sight impaired; he was very deaf, and his powers of speech, taste, and smell were deficient. There was anæsthesia of the body, and the movement of the limbs was sluggish and difficult. He continued in the hospital for nearly a month, with but little change. On April 24th, it was noticed that he was getting thinner and slightly jaundiced; he moved his arms aimlessly in an idiotic manner, and passed his urine involuntarily. On April 27th he was more restless, and even violent, shrieking out and making a loud, incoherent noise, or laughing foolishly; he passed his motions and urine beneath him. On July 7th he was in a similar state—perfectly idiotic. He died on April 7th, 1866, about a year and three months from his first exposure to the vapour; the immediate cause of death was pneumonia. The post-mortem appearances of the brain and membranes differed little from the normal state; the grey matter was pink, but otherwise healthy; there was a considerable amount of cerebro-spinal fluid; the arachnoid along the longitudinal fissure was thickened; the total weight of the brain with medulla was 41 ozs. The stomach was of enormous size; the pyramids of the kidneys were congested, as was also the small intestine; the lungs showed the usual signs of pneumonia.[919]
[919] St. Barth. Hosp. Reports, vol. ii. p. 211.