The researches of Gaspard were confined to the effects of the poison when injected at once into the blood. They show still more clearly its tendency to cause inflammation of the lungs; and they prove that through the channel of the blood, as through the cellular tissue, it is apt to cause inflammation of the stomach and rectum. The symptoms were vomiting, bloody diarrhœa, difficult breathing, apparent pain of chest, and bloody sputa; and death took place in a few seconds or in three or four days, according to the dose, which varied from one to five grains. The appearances in the dead body were principally redness in the mucous membrane of the intestines; and in the lungs, according to the length of time the animal survived, either black ecchymosed spots, or black tubercular masses, some inflamed, others gangrenous, others suppurated, or finally, regular abscesses separated from one another by healthy pulmonary tissue.[[858]]
Besides the effects mentioned in the preceding abstract, two of the experimentalists referred to have likewise observed in animals the same remarkable operation on the salivary organs which forms so conspicuous a feature in the action of the compounds of mercury on man. Dr. Campbell observed mercurial fetor, and M. Gaspard mercurial salivation. Another writer, Zeller, found that dogs might be made to salivate, but not graminivorous animals.[[859]] Schubarth, however, remarked profuse salivation in a horse, to which twenty-four ounces of strong mercurial ointment were administered in the way of friction in sixteen days:[[860]] and I observed the same symptoms in a rabbit on the sixth day after the commencement of daily mercurial inunction.
The result of the preceding inquiry is, that corrosive sublimate causes, when swallowed, corrosion of the stomach, and in whatever way it obtains entrance into the body, irritation of that organ and of the rectum, inflammation of the lungs, depressed action and perhaps also inflammation of the heart, oppression of the functions of the brain, inflammation of the salivary glands. These phenomena are diversified enough. But it will presently be found that other organs still are implicated in its effects on man.
Before proceeding, however, to its effects on man, some notice may be taken of a question, connected with its mode of action, which has long been the subject of controversy. The experiments already quoted render it probable that corrosive sublimate, before it can exert its remote action, must enter the blood; and the facts to be enumerated under the next head of the present section will render it probable that the milder compounds of mercury used in medicine also act in a similar manner. Physicians and chemists, therefore, long sought to discover this metal in the solids and fluids of the body while under its influence; and the failure of some attempts to detect it has naturally led to its presence throughout the system being called in question by many. This inquiry, besides its interest in a physiological point of view, is highly important in respect to medico-legal practice, since it forms a material branch of the general questions which at present occupy the attention of medical jurists,—whether poisons that act through the blood should be sought for by chemical analysis in other parts of the body besides the stomach, intestines, or other organ to which they have been directly applied—and in what particular quarters the search should be principally made.
In the case of mercury, the evidence of the absorption of the poison, and of its entering the tissues and secretions of the body, is now unimpeachable. This is chiefly derived from observations and experiments made on man and animals after the long-continued use of the milder preparations of mercury; it being imagined that if the poison enters the blood at all, the greatest quantity will be found under these circumstances. The facts may be arranged under three heads. Some relate to the discharge of metallic mercury from the living body during a mercurial course for medicinal purposes; others to the discovery of metallic mercury in the dead body after a mercurial course, and others to the detection of mercury by a careful chemical analysis in the fluids and solids during life or after death.
Many stories are related by the older authors of the discharge of running quicksilver from the living body during a mercurial course. Some of the most authentic of them have been collected by Zeller. In his list of cases it is stated that Schenkius met with an instance of the discharge of a spoonful of quicksilver by vomiting; that Rhodius twice remarked quicksilver pass with the urine; and that Hochstetter once saw it exhaled with the sweat.[[861]] Fallopius likewise states, that in people who had used mercurial inunction for three years, and who had the bones of the leg laid bare by suppurating nodes, he had seen quicksilver collected in globules on the tibia; and he speaks of its being the practice in his day to draw the mercury from the body, when overloaded with it, by successively amalgamating a bit of gold in the mouth and heating the amalgam to expel the mercury.[[862]] With regard to these statements of the older authors it may be observed that, although their singularity renders them questionable, they ought not to be rejected at once, as some have done, merely because corresponding facts have not been witnessed in modern times; for no one can now-a days have such opportunities for observation as were enjoyed by Fallopius and his contemporaries. The experiment of amalgamating gold in the mouth of a person under a course of mercury has always failed in modern times. But who can now have an opportunity of making the experiment during a mercurial course of three years? Besides, the statements quoted above are not all destitute of modern confirmation. Thus Fourcroy has noticed the case of a gilder attacked with an eruption of little boils, in each of which was contained a globule of quicksilver. Bruckmann mentions the case of a lady who subsequently to a course of mercury remarked after a dance many small black stains on her breast, and minute globules of quicksilver in the folds of her shift.[[863]] And Dr. Jourda has described in a late French periodical a case where fluid mercury was passed by the urine. The last fact appears satisfactory in all its circumstances. A patient had been taking corrosive sublimate for a month in the dose of a grain, besides using for the first sixteen days a gargle containing metallic mercury finely divided. Towards the close of the month he observed on the sill of the window, on which he used to turn up his chamber-pot after using it, many little globules of mercury, amounting in all to four grains. Dr. Jourda on learning this observation of his patient collected some of the urine with care, and after it had stood some time found in it a black, powdery sediment, which, when separated and dried, formed little globules of mercury.[[864]]
The next class of facts in favour of the entrance of mercury into the blood are derived from the discovery of the metal in the bodies of persons who had undergone a long mercurial course recently before death. In the German Ephemerides it is said that no less than a pound of it was found in the brain and two ounces in the skull-cap of one who had been long salivated.[[865]] This is certainly too marvellous a story. But analogous observations have been made lately. In Hufeland’s Journal it is mentioned that a skull found in a churchyard contained running quicksilver in the texture of its bones, and that there is preserved in the Lubben cabinet of midwifery a pelvis infiltered with mercury, and taken from a young woman who died of syphilis.[[866]] An unequivocal fact of the same nature has been related by Mr. Rigby Brodbelt. In a body of which he could not learn the history he found mercurial globules as big as a pin-head lying on the os hyoides, laryngeal cartilages, frontal bone, sternum, and tibia.[[867]] Another equally unquestionable fact of the kind has been supplied by Dr. Otto. On scraping the periosteum of several of the bones of a man who had laboured under syphilis, he remarked minute globules issuing from the osseous substance: in some places globules were deposited between the bone and periosteum, where the latter had been detached in the progress of putrefaction; and in other places, when the bones were struck, a shower of fine globules fell from them.[[868]] Wibmer observes that Fricke, surgeon to the Hamburg Infirmary, has obtained mercury by boiling the bones of persons who had been long under a course of mercurial inunction.[[869]]
The third and most satisfactory class of facts are the result of actual chemical analysis. These results were long variable. On the one hand, Mayer, Marabelli,[[870]] and Devergie,[[871]] failed to detect mercury in the fluids of people under a mercurial course; and I myself,[[872]] as well as Dr. Samuel Wright,[[873]] had no better success in some experiments on animals. On the other hand, Zeller detected it after death in the blood and bile, Cantu procured it from the urine, Buchner found it in the blood, saliva, and urine, and Schubarth extracted it from the blood. The first experimentalist found that in the blood and bile of animals killed by mercurial inunction, mercury could be detected by destructive distillation, but not by any fluid tests.[[874]] Cantu, by operating on sixty pounds of urine, taken from persons under the action of mercury, procured no less than twenty grains of the metal from the sediment.[[875]] The experiments of Buchner are very satisfactory. By destructive distillation of the crassamentum of seven ounces of blood taken from a patient who was salivated by mercury, he obtained rather more than a quarter of a grain of globules; two pounds of saliva yielded in the same way a 200th of a grain; and the urine contained so much that it became brownish-black with sulphuretted-hydrogen.[[876]] Buchner likewise adds, that Professor Pickel of Würzburg procured mercury by destructive distillation from the brain of a venereal patient who had long taken corrosive sublimate.[[877]] Not less satisfactory are the experiments of Dr. Schubarth. A horse after being rubbed for twenty-nine days with mercurial ointment to the total amount of eighty ounces, died of fever, emaciation, diarrhœa, and ptyalism. On the sixteenth day, when ptyalism had set in, a quart of blood was drawn from the jugular vein, and after death another quart was collected from the heart, great vessels and lungs,—extreme care being taken to collect it perfectly pure. In each specimen there was procured by destructive distillation a liquor, in which minute metallic globules were visible. A copper coin agitated in the liquor was whitened; and when the oily matter was separated by filtration and boiling in alcohol, the residue gave with nitric acid a solution, which produced an orange precipitate with hydriodate of potass.
These researches were considered adequate to prove the strong probability of the absorption of mercurial preparations when introduced into the animal. But the frequency with which negative results were obtained by competent inquirers, and in circumstances apparently favourable, threw an air of doubt over the positive facts, however clear they seem to be in themselves,—till at length Professor Orfila proved by a series of careful experiments that the cause of failure must generally have been the want of a process sufficiently delicate: for in all ordinary circumstances, by using his process described above, he succeeded in obtaining mercury in the urine and liver of animals poisoned with corrosive sublimate, as well as in the urine of patients who were taking that salt in medicinal doses. He could not detect it, however, in the blood.[[878]] Since these investigations, Professor Landerer of Athens detected mercury in the brain, liver, lungs and spinal cord of a man who poisoned himself with two ounces and a half of corrosive sublimate;[[879]] and M. Audouard has twice found it in the urine and once in the saliva of persons salivated with mercury, by simply transmitting chlorine, exposing the liquid to the air for a day, evaporating it nearly to dryness, dissolving the residue in water slightly acidulated with hydrochloric acid, immersing copper-leaf for twenty-four hours, and heating the stained portions in a tube.[[880]]
The cases of poisoning with the preparations of mercury, which have been observed in the human subject, may be conveniently arranged under three varieties. In one variety the sole or leading symptoms are those of violent irritation of the alimentary canal. In another the symptoms are at first the same as in the former, but subsequently become united with salivation and inflammation of the mouth, or some of the other disorders incident to mercurial erethysm, as it is called. In a third variety the preliminary stage of irritation in the alimentary canal is wanting, and the symptoms are from beginning to end those of mercurial erethysm in one or another of its multifarious forms.