(3) Abdominal ptyalism. – This effect of Mercury is rare, but does occur. It is characterized by frothy, whitish, tenacious, sometimes greenish stool, as many as fifteen in the course of a day; at first they are attended with colicky pains, afterwards they are attended with colicky pains, afterwards they are painless, with a dull burning pain in the region of the pancreas, and a sensation as if something were coming away from this spot. This region is painful when pressed upon. If violent, this symptom may become dangerous to life.
(4) Hydrargyria, or the mercurial eczema. – A febrile exanthem, consisting of small itching vesicles, crowded together upon a skin having an erysipelatous redness; they are filled with a yellowish lymph, peel off like bran, and are said to occur only after Mercurial frictions. In other cases the skin assumes a scarlet-redness, the vesicles burst, cover the surface of the skin with a viscid fetid fluid, after which, about the fifth day, the epidermis peels off in large patches, leaving sore places of considerable size.
(5) Mercurial rash. – A febrile exanthem, which is preceded by anxiety and restlessness, first breaks out on the chest, and, after effecting several partial manifestations every day, for four or five days to come, finally completes its development at the end of this period. The rash is white, and densely crowded together. The fever is of a torpid character, and accompanied by nervous symptoms.
These two exanthems, which, when breaking out after massive dose of quicksilver or after frictions with mercurial ointment, are always acute and attended with fever, may likewise assume a chronic form, after smaller doses of Mercury, as may be seen from the following observations of Hahnemann, and his son Frederick, volume I of the Materia Medica Pura: Eruption consisting of red, raised spots, with stinging itching; small, transparent vesicles, full of watery fluid, breaking out on various parts of the body early, before daylight; rounded stigmata, gradually changing to ulcerated spots, which become scurfy; rash over the whole body, specially on the chest, thighs, and on the lower part of the back; measle-shaped rash, with burning and itching; eruption consisting of small red, raised spots, with stinging and itching; nettle-rash, afterwards changing to red spots. Erysipelatous inflammations.
Secale 216. – Chronic Forms of Mercurial Poisoning.
Under this head, it may suffice to direct attention to the external alterations, approximating those of syphilis.
(1) Swellings. – Among these we not only have inguinal swellings but likewise swellings of the axillary and parotid glands, of the pancrease, and mesenteric ganglia. What Dieterich relates, after Matthias, of fig-warts and ganglia, supposed to have been caused by Mercury, most likely applies to syphilitic rather than a mercurial poisoning. The swelling of the testicles, of which the same author makes mention in his work, is more likely to have been caused by the gonorrhoea for which the calomel was given, than by the calomel itself.
(2) Chronic eruptions. – Here we have principally: Eruption on the hairy scalp, with itching, which induces one to scratch; scurfs on the hairy scalp, with itching, and burning after scratching; elevated scurfs, matting the hair together; humid eruption, which eats away the hair, with itching of the sore parts; painful blisters on the nose; large tubercles beneath the integuments of the cheek; red spots in the face; pustules on the chin, of the size of a pea; millet-sized, ulcerated, eruption on the chin, with yellow crusts underneath; reddish-white herpetic spot on the zygoma; red elevations on the arm, with white-scurfy itching tips, and burning after scratching; large, round scaly spots on the forearm and wrist, with burning pain; letter on the forearm, with voluptuous itching, desquamation of the skin; peeling off of the dorsum of the hand; itch like eruption on the hands, with nocturnal itching, and a raging pain in the forehead; vesicles on the wrists, full, of a watery fluid; red papulae on the dorsum of the hand, with burning when first breaking out; exfoliation and falling off of the nails; itching eruption on the thighs, with oozing of a burning water after scratching; herpes on the thigh, with voluptuous itching, and peeling off of the epidermis after scratching; gnawing-itching little ulcers on the thigh, inviting one to scratch; small, itching pimples on the leg, changing to ulcerated spots, the epidermis peels off after the ulcers heal; eruption resembling pustules scabies on the legs, sexual parts, in the bend of the knee, on the neck and abdomen, very much raised, red, as if sore, humid and itching; pustules on the upper and lower limbs, with purulent tips, itching herpes, with burning when touched; dry, raised, burning itching tetter on the legs, arms, hands, and between the fingers; ulcerated patches on the joints of the fingers; deep cracks and rhagades in the hands and fingers.
(3) Ulcers. – Phagedaenic ulcers; spongy, bluish, readily- bleeding ulcers; ulcers that look as if they had been gnawed at by insects, unequal elevations and depressions, great painfulness to contact, and discharge of an acrid, corrosive ichor; cracks and rhagades in the lips; soft, red, ulcerated patches in the swollen upper lip, with discharge of a watery, yellowish, fetid fluid; they bleed when touched, and itch furiously; bluish-white spots and painful ulcers on the inside of the lower lip; ulceration of the corners of the mouth; rhagades in the prepuce, with swelling of this part, which is covered with a red, fine rash; while vesicles on the glans, spreading and dipping down to the subjacent textures; small ulcers on the inside of the prepuce, having originated in small vesicles; round ulcers beneath the prepuce, with everted edges looking like raw flesh, with a cheesy bottom, discharge of a yellowish-white, strong- smelling matter, much bleeding and pain to contact that seems to be felt throughout the whole body; suppuration between the glans and prepuce, with redness, swelling and inflammation of the latter.
(4) Affections of the mucous membranes. – Discharge of greenish mucus from the urethra; discharge of acrid pus from the nose, smelling like old cheese; swelling and cracking of the Schneiderian membrane; scurfy nostrils, they bleed when one blows the nose; (oedematous swelling of the root of the nose); discharge of a yellowish, fetid, bloody pus from the ear; soreness and excoriation of the inner ear; soreness in the mouth; round, elevated, white blisters in the mouth; aphthae, ulcers, and ulcerated patches on the buccal mucous membrane, with burning and smarting; ulceration of the margin of the tongue, becoming indented from the pressure of the teeth; the tongue is hollowed out, ulcerates, with swelling.
(5) Affections of the osseous system. – Carious ulcers; caries and abscesses in the joints; thickening of the periosteum; swelling of bones; pain of the skull-bones, occipital region; pain of the nasal bone when touching it; caries of the maxillary and palatine bones; hard elevation on the right tibia, with shining redness and swelling; fragility of the bones, preceded by rheumatic pains.
Secale 217. – Diagnosis, Prognosis and Treatment.
We omit the balance of mercurial ailments, such as tremor, laming rheumatism, nervous stuttering, neuralgia, melancholy with complete depression of all bodily and moral energy; they are well known, and will not escape the attention of the cautious physician in case they should occur under the homoeopathic treatment of syphilitic affections with somewhat large doses of Mercury. A few diagnostic, prognostic, and therapeutic remarks on mercurial poisoning may however, not be out of place.
In regard to diagnosis, the difficulty is not so very great, provided we remember that: (1) all mercurial cutaneous affections and distinguished from analogous syphilitic pustules, papules, herpes, or ulcers, by the itching, which, is never wanting with mercurial, and scarcely ever present in syphilitic eruptions; and (2) that mercurial ulcers are always more superficial, and that their edges have a bluish-white color; at the same time they have not the rounded, cup-shaped appearance of syphilitic ulcers, nor are their edges as callous or copper-colored as those of the latter. Moreover, mercurial symptoms, provided the metal is discontinued, disappear within ten or thirty days, although they show a disposition to return again. In other respects, the case is same with the mercurial disease as with syphilis; a single symptom of the former malady is scarcely ever seen alone, they always appear in company, although, if they are very slight, it requires a practised eye to discover and recognize them.
The prognosis depends upon the quantity of Mercury that has been crowded into the body. What must not be overlooked in this disease, is the recurrence of the paroxysms every six months, or even every year; the mercurial symptoms may be entirely subdued during this period, and yet the poison may still be haunting the organic tissues. The worst is, that massive doses of this metal are sometimes given in rapid succession without causing any perceptible ill-effects, until the disease breaks out all at once in all its violence, which may happen even six months or a year after the metal had been entirely discontinued. If moderate doses of this drug do not produce a decided improvement of the syphilitic disease within a reasonable period, on the contrary, aggravate it, it would be criminal to continue its sue any longer for the purpose, as it is called, “of saturating the organism,” in the fancied security that because no perceptible effect of Mercury has as yet shown itself, there cannot be any danger in continuing the desperate game a little longer. If the metal has not been abused to excess, and the effects of its use only break out some time after it had been discontinued, the prognosis is not so very unfavorable, although, on account of the symptoms being liable to break out afresh, the cure is rather slow; on the other hand, if the symptoms break out while the patient is still taking large doses of the drug, the acuteness and violence of the disorder may result in a speedy destruction of organic life. In this respect, the worst symptoms are those described in No.215, hydrargyria and the mercurial rash.
