Mercurius

Hydrargyrum, an elementary body. (Mercurius virus. Quicksilver.)

Preparation for use. Triturations.

Authorities.^ 1, A. De Haen, effects on a gilder. Ratio Medendi, p. 229 (Leyden, 1661); 2, Walter Pope, effects on laborers in quicksilver mines in Italy, Philos. Trans., 1665, 1, p. 21; 2 a, Scopola, effects on workers in the mines in Idria, Venice, 1671; 3, John Person Hain, effects on self of handling or being in the same room with the metal or any of its compounds, Bunetus, Med. Septeudri. Coll., Geneva, 1686, 2, 386; 4, Jussieu, effects on workers in quicksilver mines of Almada, Spain, Mem. de I’Acad. Roy. des Sciences, 1719, p. 358 ; 5, Ramazzini, effects on gilders. Op. Med. et Phys. (de morb. artificium), 1719, p. 486; 6, Junchen, general effects in gilders, from Ramazzini; 7, Fernelius, effects in a gilder, from Ramazzini; 8, Forests, effects in a gilder, from Ramazzini; 9, Borichius, effects in a gilder, from Ramazzini; 10, Fourcroy, effects in a gilder, note to a translation of Ramazzini (from Swediaur, Traite des Mai. Syphil.) ; 11, same, effects on wife of preceding, who also slept in the workroom ; 11a, Trew, effects in a woman, aged sixty, from silvering mirrors. Act. Phys. Med. 1737; 12, Spens, effect in a Woman, aged thirty-six, of rubbing ointment of Merc, into groins and upon some hjemorrhoids, Edin. M. and S. J., 1805; 13, same, effect in a man, of mercurial pill and ointment continued six weeks for bubo ; 14, District, “ Mercurial Diseases,” general effects (from Hempel, Mat. Med.); 15, Thackrah, effects in gilders, ibid.; 16, Wm. Stokes, effects from silvering mirrors, Ryan’s Med. J., 5,520; 17, Kopp, from Hempel, effects in a gilder; 18, Kussmaul, Uiiters. neb. d. Constitutiouelleo Mercurialismus, 1861, detailed effects in over one hundred workers in Erlangen; 19, Herrmann, effects in workers, from Kussmaul; 20, Keller, effects on workers in Bohemia, from Kussmaul; 21, Bajumler, effects on workers, from Kussmaul; 22, same, effect in a woman aged twenty-eight; 23, Kussmaul, op. cit., effects on workers in Forth; 24, Fronmuller, effects on workers, from Kussmaul; 25, Goetz, effects on workers, from Kussmaul; 26, Ascherson, effect on a man, from Kussmaul; 27, Hessler, Journeys, Hanover, 1740, effects in workers in mines, from Kussmaul; 28, Weerheeck du Chateau, effects on workers in Prague, 1814, from Kussmaul; 29, Bayer, Horn’s Archiv, 1820, effects in workers, from Kussmaul; 30, Sundelin, effects on workers, from Kussmaul; 31, Mitchell, effects on workers. Loud. Med. and Phys. Jour., 1831, from Kussmaul ; 32, Raver, effects on workers, Anna!, de Therap, 1846, from Kussmaul ; 33, Constant, effects in thirty-four cases among workers, Clin. Ruck. Blatt., 1848, from Kussmaul; 34, Van Berger, Deutsch. Clin. 1850, effects on workers; 35, Passot, effects on workers, Gaz. Med. de Lyon, 1852, from Kussmaul; 36, Koch, effects on workers, Canstatt’s Jahrh., 1855; 37, Pleischl, effects on workers, Oest. Zeit. f Prak. Heilk., 1856; 38, Petters, effects on workers, Prague, Vjhrt., 1856; 39, Baldinger, luaug. Hiss., M iirtsburg, 1861, effects in workers; 40, omitted; 41, Sigmund, general effects, Bost. M. and S. J., 18, 362; 42, same, effect in a man, of 22 ounces of crude metal, taken in five days; 43, Burden, effects on silverers of mirrors, Diet, des Sciences Med., 54, 276 ; 44, Chron, effects of carrying Merc, in a leather bag about the neck, Hygeia, 11, 514; 45, Axille Med., 1853, effects in a “silverer;” 46, Edin. M. and S. J., 6, 513, effects of' a large quantity (30 tons) stowed on shipboard; 47, Colon, effects on physicians and students from inhaling mercurialized atmosphere in a syphilitic hospital, Arch. Gen. de Med., 1826, p. 71; 47 or, same, effects of mercurial inunction for itch, in two women ; 48, R. Bright, effects on a workman exposed to vapor of mercury. Rep. of Med. Cases, London, 1831; 49, same, effects in a man and woman from fine particles of triturated Mercury ; 50, same, effects in a gilder; 51, Bateman, effects in two “ silverers,” Edin. Med. and Surg. J., 8, 376; 52, same, Bost. M. and S. J., 18, 138; 53, Arrowsmith, effects on a “water gilder,” Loud. Med. Gaz., Apr. 1834; 54, same, another case ; 55, Peyrot, effects on a “silverer,” Arch. Gen. de Med., 1834; 56, Olivier and Roger, effects of vapor of distilling Merc, on two girls aged seven and ten, Ann. d’Hyg., 1841; 57, Grain, effects in a man of sleeping in a room in which a wooden bowl that had held Mercury had been burnt in a leaky stove. Arch. Gen. de Med., 1845, p. 328; 58, same, effects on wife, aged fifty-six; 59, same, effects on daughter, aged twentyone ; 60, same, effects on daughter, aged sixteen ; 61, Porter, general effects. Am. J. Med. Sc., 1847, p. 245; 62, effects of fumigating with merc. a hospital ward infested with bugs, Journ. de Chim. Med., 1849; 63, Large, effects of ointment in children with lice, Med. Zeit., 1851; 64, Barlow, effects in a gilder, Med. Times and Gaz., 1853; 65, Christison, effects in workmen ; 66, Falconer, effects of a girdle containing Mercury worn about the waist for the cure of itch, Bost. M. and S. J., 18,138 ; 67, Earle, effects in a gilder, Bost. M. and S. J., 7, 274; 68, Oppolzer, effects in a woman employed in making barometers, Oest. Zeit. f. Pr. Heilk., 1857 ; 69, Bricheteau, effects in a gilder. Bull. Gen. de Therap., 1866; 70, Leroy, effects in a woman working in skins that had been treated with Mercury, I’Union Med., 1867 ; 71, Tilbury Fox, effect of inunction. Lancet, 1867 ; 72, Ramskill, effects in a silverer, Lancet, 1868; 73, Errand, effects in a woman of sleeping in a room where Merc, had been volatilized, Union Med., 1868 ; 74, Guinea de Mussy, effects on a man, aged thirty-seven, of “silvering” for two years, Gaz. des Hop., 1868 ; 75, Gallon, effects in two workers, Schm. Jahrb., 86, 239; 76, Gailleton, general effects, I’Union Med., 1867; 77, same as 74; 78, Concave, effects on workers. Revista Clin., 1868, S. J., 145, 144; 79, Schmitz Inaug. Diss., 1869, effects of silvering; 80, same, another case exposed to vapor of Merc.; 81, Morrison, effects of strongly inhaling from an old vial containing the 4th dec.. Month. Horn. Rev., 1875, p. 33; 82, same, effect on Dr. J. B.; 83, Sharp, Essays on Med., p. 725, effects of-I gr. of first or second trit., taken night and morning.t

Mind p. 210

Emotional. Mind easily agitated

Occasionally his mind seemed to wander

Frightful images at night

Hallucinations day and night

Hallucination of mind, especially at night, with desire to escape

Delirium; his speech was disconnected, and he would not answer questions; this delirium increased to a violent rage, so that the patient was obliged to be confined in a strait-jacket, with rolling of the eyeballs, clonic spasms, discharge of yellow, frothy liquid from the mouth and nose, and rattling in the trachea, followed by trismus and tetanus

Delirium

Delirium, like delirium tremens

Nightly delirium

* Muttering delirium

Constant weeping (elder)

Sadness

Low-spirited

Spirits depressed

Anxious

Attacks of frightful anxiety

Great excitability; easily frightened

Great irritability

Very irritable disposition

When in the state of tremor, his temper became more irritable, and anger, in turn, so increased the trembling, that he was obliged to sit down to save himself from falling,V

Ill-humor

Ill-humored ; the patient was very fretful and peevish ; easily excited

Ill-humor and great irritability

Fretful mood

Very fretful mood

liitellecfual. *Slow in answering questions (after thirty-six years)

Thoughts wandering, and impulses whimsical (elder)

Intellect affected; when asked to explain any statement, he becomes confused

Weakness of intellect and memory

Intellect very weak; shoxvs every murk of imbecility; smiles foolishly; screams constantly without apparent cause; can speak only a few disconnected words; does not seem to understand the simplest questions, yet appears to know her sister with whom she plays, and repeats a few syllables of what the latter has said to her (younger)

Loss of intellect and memory; a sort of idiocy, which in a few years becomes permanent

Loss of memory

Complete loss of memory

Memory slightly affected ; forgot the names of persons and places, and was frequently at a loss in endeavoring to recollect the persons to whom he had lent his tools

Ttlemory weak

Weakness of memory and loss of will power

Increasing weakness of memory

Very poor memory (after thirty-eight years)

Memory very much impaired

Forgetfulness, with impaired intellect

Very forgetful

Loss of consciousness

Stupor

Constant disposition to lie down ; inclined to sopor, coma

Head p. 210

Confusion and Vertigo. Confusion of the head

Confusion and heaviness of the head

Ferfiyo

Vertigo, even to falling down

Vertigo only in the evening

Vertigo on ascending or descending steps

Vertigo, with raging headaches

Attacks of vertigo, worse iu the evening; if he was not lying in bed he would suddenly fall down, with flickering before the eyes, sometimes with complete loss of consciousness lasting several minutes ; during these attacks he looked very pale, and sometimes had nausea and vomiting; vertigo occurred even in bed, and once in the morning he became unconscious and fell out of bed

Almost incessant vertigo

Great vertigo

Violent vertigo, so that sometimes he fell down like one intoxicated

Vertigo, frequently very violent

Giddiness

Occasional giddiness

Gen eral Head, Such trembling of the head as almost entirely prevented her from falling asleep

* Constant rotary motion of head, even when lying on the pil-

Congestion of the brain

Fatal apoplexy

Heaviness of the head

Slight pain and heat about head

Headache, ’® ®’, etc.

Rose with a headache every morning

Headache, which keeps him awake, with twitching pain in the belly and back

Headache and vertigo, especially violent after a glass of beer

Frequent headache and vertigo

A great deal of headache

Great headache

Violent headache

Violent headache, with a sensation as though he were pulled back- -ward

Constant and violent headache, having no fixed seat

Most violent headache

Frightful headache

Fulness, throbbing, and vertigo in head (after a few minutes)

The headache was usually violent day and night, generally described as a drawing rather than a tearing pain, involving sometimes the forehead, sometimes the occiput

Throbbing headache, with vertigo

Forehead. A good deal of pain in forehead

Pain in the left side of the forehead, aggravated by pressure upon the nodal point

Frontal headache, with fulness, soon passing to the occiput, with vertigo (after twenty minutes)

Frontal bursting headache (after a few minutes)

Bursting frontal headache, lasting several minutes (third day)

Temple. Subacute aching above left temple (second morning)

External Head. Falling of the hair

Itching of scalp (after a few minutes)

* Profuse falling of the hair

Eyes p. 211

Objective. Staring eye, with watery obscuration

Eyes swollen

Eyes sunken, surrounded by blue rings

Eyes sunken, surrounded by brown rings

* Eyes inflamed, with swollen inverted tarsi, and very sensitive to light

Blennorrhoea of both eyes

Soft cataract of the left eye (after some years)

Keratitis and sclerotitis

Eyes weak

Eyes weak, bleared

Lids. Eyelids jerked when the lids were closed

Conjunctiva Chronic conjimctivitis, with a fine, rosy red injection around the cornea

Blennorrhoea of both conjunctivie

Eupil. Pupils dilated

Pupils greatly contracted, scarcely reacting at all to the light

(No case of syphilitic iritis, and no ease of iritis of any form, has been noticed among the workers)

Vision. Diminution of vision

Dimness of vision,^^'

Vision7i weak; examination with an ophthalmoscope showed an atheroma of the left arteria centralis retinae

Weakness of vision, so that he could with difficulty read No. 7 of the test type

Mist before the eyes; inability to read

[HO-] Sight of left eye considerably impaired

Flickering before the eyes

Flickering before the eyes while reading, though the accommodation seems to be unimpaired

Play of colors before the eyes

Ears p. 211

Burning in right ear (after a few minutes)

Paraplegia of the left ear

Hearing, Remarkable exaggeration of sensibility ; the noise of a horse or carriage made him start to such a degree that several times he would have been run over had he not kept close to the walls or shopfronts. He was then obliged to stop for fear of falling; he could not express the disagreeable sensation which the noise occasioned

Diminished hearing

Difficulty of hearing.

Difficulty of hearing, with roaring in the right ear

Deafness

Roaring in the ears

Violent roaring in the ears

Nose p. 212

Objective. Nasal catarrh, with thin discharge; frequently with loss of smell and with hoarseness (after working fourteen days)

* Constant nasal catarrh

Complete nasal obstruction, right side, soon passing off, at 8 a.m. (second day)

Subjective. Congestive fulness and stuffiness in nostrils, especially right side (after a few minutes)

Pinching sensation in right ala nasi (after a few minutes)

Irritation of nasal mucous membrane, as from catarrh (after twenty minutes)

Face p. 212

Objective. Dull-looking countenance (after thirty-eight years)

Stupid expression of face (younger)

Cadaverous appearance

Cadaverous countenance

Yellow, cadaverous face

Cachectic complexion,’k

* Face earthy-colored, puffy,^k

Color of the face dirty-greenish

Pale-yellow color of the face

* Sallow

Countenance sallow

Face pale,; with a look of intoxication

* Face pale and bloated (after thirty-eight years)

LookedpaleF•

Sickly, pale look

Face swollen

Wrinkled face, with a prematurely aged look

Twitching of the facial muscles

Face distorted by twitching of the muscles

Facial muscles slightly affected

Subjective. Pain, especially in the lower jaw

Tearing pains in the face

Cheehs. In one case the cheeks became thick

Lips Deep fissures in the corners of the ynotdhfi.

Trembling about the corners of the mouth, especially when talking

Chin. Lower jaw of right side, after several years, was remarkably thin

* Almost complete inability to move the lower jaw or chew

Unable to masticate (after nine days)

Mastication painful and even impossible (second day)

Inflammation of the lower jaw progressing to caries, with falling out of the teeth

Atrophy of alveolar process of the lower jaw

Periostitis of the lower jaw

In one case periostitis of the lower jaw without subsequent necrosis

Necrosis of the jaws

Mouth p. 212

Teeth. *Teeth black, loose

Teeth turn yellow and become loose

Thick gray coating on the teeth (after working fourteen days)

Teeth dirty-gray, loose

Teeth foul

Teeth thickly covered with tartar

* Carious teeth

Decay of the teeth ; they become loose in succession, and at the age of thirty she had lost six; they fell out at the slightest shock (after six years) ; most of the teeth, especially the molars, were gone; those that remained ^(;ere blackened, laid bare, loose and carious (after thirty-eight years)

* After a time, the teeth decay, become loose, of a grayish color, and fall out

Since going into the works, he has been obliged to have several teeth removed

All the teeth were loose

* Teeth loose, discolor ed

* Teeth loose; at last drop out

The teeth, especially the anterior back ones, are loose, and would fall out

Looseness of the teeth, especially of the molars; they become denuded of the gum and turn black, with nightly pains in the teeth, jaws, and head

Teeth very loose (after ten days)

Falling out of teeth

Falling out of the teeth

Loss of nearly all the teeth ; gum-boils formed close to their roots, and they soon after dropped out

All the teeth except the incisors have been lost, at least the crowns of the teeth, leaving only the roots, with very red gums, which are very softfi.

Disagreeable sensation in the teeth

Aching in right lower molar (decayed) at 4.30 p.m. (second day)

Violent pain in the teeth (after six years)

Aching in left lower molar (sound), passing to upper molar (sound), at 6 p.m. (second day)

Slight aching in left lower molar tooth (sound), (after two hours and a quarter)

Violent toothache

Violent toothache, with swelling of the gum and salivary glands

Toothache (drawing) in left lower molar (sound); (not experienced for several years), (after a few minutes)

■ Gins, Gums much affected

* Girns red, but without yellow coating on free border (eighth day)

* Gums red, swollen, and covered with thin white patches, easily removed from a non-ulcerated surface; to the left of and behind the second molar tooth, a red patch which has been covered by a white film. Gums much worn away, and coated of a dirty yellow (after ten days)

Gums red, swollen, and covered on their free border with a dirty yellowish-white substance, which extends up to the tooth-cavities. On removing this, the subjacent surface is seen to be spongy and bleeding, without ulcerations

* Gums red, and bleeding at the slightest contact, sometimes spontaneously (after six years). Of a deeper red, and slightly swollen (after eighteen years). Red, bleeding in spots, but do not seem swollen; small ulcers on them at intervals (after thirty-eight years)

* The gum has a bright-red margin

The margin of the gum shows a bluish-gray color and seems inflamed

Gingival line

* Gums swollen and of a divided color

Gum swollen, with a light violet margin

* Guns szvollen, separated from the feet/i

Gums swollen, painful

In 1822, two eleven externes at the Venereal Hospital, were affected with a considerable swelling o'f the gums, which lasted all the time they were employed there. Merely withdrawing from the hospital sufficed to cure the complaint. I myself was troubled in the same way, while serving in the same capacity at the institution. After residing there for about six weeks, my gums swelled so badly that they were very sore, and bled at the least touch. I could not eat bread without pain, and my food was bloody avhen chewed. Nothing gave entire relief until I left the hospital

* Gums frequently become soft and bleeding

* Gums spongy and bleeding

* Gums spongy, and covered xvith pultaceous exudation

* Gum very spongy, and partly destroyed

* Gums ulcerated

* Gum ulcerated, loose, spongy, offensive

* Suppuration between the teeth and gum

Gums somewhat worn away, red, swollen, covered with white films; free edges entirely coated of a yellowish-gray tatter nine days)

His gums, without much sponginess, had been gradually absorbed, and most of his teeth had fallen out; ptyalism had never occurred

’^Atrophy of the gum, especially of the lower anterior portion

* The gum atrophies, especially on the roots of the lower teeth, leaving the necks of the teeth bare

* Gum atrophied and retracted below the alveolar process

* Bleeding from the gums

* Gum bleeds easily

Gum painfid

Gums and mastication painful (second day)

* Gums sore

Tiniifne. *Tongue black, with red edges

Tongue red, swollen

* Tongue not swollen; gray patches on edges, and a thin dirty-yellow coat on upper surface (after nine days)

* Tonguepale

* Tongue white f ®

* Tongue white, tremulous

* W kite-coated tongue

* Coated tongue, showing the impress of the teeth upon the margin

* Tongue thickly coated

Tongue swollen, and its movements difficult (second day)

* Tongue much szvollen, and difficult to move (after eight days)

Tongue much swollen, especially on the left side; its upper surface covered with a dirty-yellowish coating, and with gray patches on its edges; its movements are difficult

* Tongue very much swollen, painful, and covered with foul ulcers, with constant oozing of blood as from a spongy tissue; these ulcers made swallowing very difficult

* Tongue so much swollen that its movements are difficult and very painfid; it is very red, with a dirty-yellow coating on upper surface; shows marks of teeth, and has large gray patches on edges (after eight days)

Great swelling of the tongue, especially of the right side, which was covered with superficial ulcers; the swollen portion of the tongue and mouth were hard to touch, the tongue and palate bright-red, extremely painful, submaxillary and cervical glands swollen and sensitive to pressure

Tongue very large, especially on right side; its edges show gray patches; in front it bears the marks of the teeth; its upper surface presents the dirty-yellow coating characteristic of mercurial poisoning; its movements are difficult (after ten days)

* Trembling of the tongue

* Constant trembling of tongue

* Great trembling of the tongue

Tongue looks healthy, and is not coated; but almost as soon as it is put out it begins to vibrate like a pendulum ; at first in small arcs, which rapidly enlarge if the organ is kept protruded (after thirty-eight years),™.

Tongue difficult to move,^h

Tongue cracked, with a dirty-white coating

Ulcers on the tongue,™.

Long, pale ulcers on the edges of the tongue near its tip

The patches on the edges of the tongue begin to disappear, and the red elevations to show themselves (after twenty days). The ulcers on the edges of the tongue, which are 41 centimetres in length, are cicatrized in their anterior third. The posterior two-thirds of the left ulceration shows a granulated surface 3 minims. in breadth. The right ulceration has a granulated surface rising above the healthy mucous membrane, and about 3 minims. in length (after twenty-two days). The ulcer on the left border of the tongue has cicatrized; a white line marks the boundary of the cicatrix. The ulcer on the right edge of the tongue is not more than 3 minims. in length; it forms a raised granulated surface, with a white border, which cuts it transversely in several places, so as to divide it, as it were, into islets. This granulated surface projects above the white border, which is a true cicatrized edge (after twenty-five days)

On the right border of the tongue, instead of the gray patch, a granulated surface stands out plainly upon the healthy mucous membrane, which bleeds on the slightest touch, and has the white edging of a true cicatrix. There is a similar appearance on the left border (after sixteen days)

Pain in the tongue, with blisters on the margin developing into ulcers

General 3Jhonth. Mucous membrane of the mouth very much affected

Mucous membrane of the palate red, with an ulcer to the left of the uvula

* The mucous membrane of the palate is intensely red and cedematously swollen

The mucous membrane assumes a bluish-red appearance in one or more places, and becomes spongy ; next day these spots become whitish, and the dissolution of the mucous membrane becomes evident; in a few hours the whitish-gray substance changes to a fetid ichor, flows off, and exhibits an irregular, shaggy, flat -ulcer, with an almost spongy base, and sharply indented edges; the ichor is discharged in profuse quantity, the ulcer spreads rapidly in extent, without penetrating into the flesh, and is very painful; if the use of the metal be continued, and the ulcers left to themselves, they assume a dirty, foul appearance, and become rapidly phagedenic; blood is now discharged from the ulcers, not actively, but oozing out as from a sponge, and evincing a state of great debility ; the bottoms of these ulcers often present unequal elevations and depressions, as if it had been corroded by insects; the breaking out of these sores is often accompanied by irregular and quick pulse, sleeplessness, restlessness, profuse night-sweats, great nervousness, and impatience from the slightest cause

Copper-colored redness and swelling of the gum and mucous membrane of the mouth, followed by excoriations of the inner surface of the lips and gums, and moderate salivation (after working fourteen days)

Mucous membrane of the mouth livid, with moderate salivation, especially in the morning; gum red, elevated, with a grayish-red margin, cons membrane of the mouth pale, xvith numerous erosions

The mucous membrane of the lower lip, especially on the left side, is covered with large yellowish patches, which cannot be detached by the finger-nail. Buccal mucous membrane swollen, red, thickened, and covered on the cheeks, gums, and palate, with white patches which are easily detached from a non-ulcerated surface. The gray patches on the lower lip and inside the cheeks, and on the edge of the tongue, were bordered by a red line (after four days). On removing with a cloth the patches which extended from the lower lip over the inside of the cheeks, the mucous membrane was laid bare, and was seen to be rough and uneven, staining the cloth with a good deal of blood. Severe pain was thus caused (after six days). The gray patches have disappeared, leaving red spots. On the right cheek, near the labial commissure, is a reddish-gray surface, as large as half a dollar, raised above the healthy mucous membrane. The red spots are true granulations, indicating ulceration of the mucous membrane; the gray places are remnants of the previous white patches (after thirteen days),“k

Buccal mucous membrane swollen and painful (second day). Mucous membrane of inside cheeks swollen, especially on right side, where is a red patch which has been covered by a white film. The palate also shows some of these films. The mucous membrane of the lower lip presents thinnish white patches, bordered with red (after ten days). The wdiite patches on the lower lip are replaced by a surface covered with small red elevations, having a thin gray coating between them. This granulated surface stands out in bold relief upon the healthy mucous membrane, and leaves blood on the cloth when touched ; contact is very painful (after eleven days)

Buccal mucous membrane lining the upper lip presents, near the right commissure, a thick white patch, bordered with red; the inside of lower lip is entirely covered with moderately thick, gray patches, also bordered with red. Mucous lining of cheeks swollen, especially on right side ; it, as well as the palate, shows thin white films (after nine days)

Palate almost entirely covered by a thin false membrane, which can be removed from a non-ulcerated surface. Buccal mucous membrane partly covered with thin white patches, but in some places there are thick layers which cannot be wholly removed by the nail (after eight days). Patches on inside cheek, bordered with red (after ten days). Patch on right cheek has gone off, and is replaced by a prominent grayish-red surface; the red points are evidently granulations; the gray points are remains of the false membrane (after eleven days). Granulations on the above places in left cheek; more apparent in right cheek (after twelve days). In right cheek a granulated surface, 1 millimetre in breadth and 5 millimetres in length ; around it the mucous membrane is red to the extent of 6 millimetres (after twenty-five days)

* Bad odor from the mouth

* Mouth extremely offensive

Fetor from the mouth

* Fetid odor from mouth

Mercurial odor very strong (after eight days)

* Odor from the mouth disagreeable, sweetish

Swelling of the gum, lips, and cheeks

Mucous membrane of the mouth swollen, elevated

Spongy swelling of the mucous membrane of the lower lip, with numerous pustules looking like swollen mucous glands; also the mucous membrane of the cheek and upper lip has a peculiar spongy appearance

Stomatitis in two-thirds of all the cases. sometimes with swelling of the cervical and submaxillary glands; in about one-half of the cases there were mercurial ulcers in the mouth ; in one case, inflammation of the tongue; in another case, inflammation of the tonsils and formation of an abscess

* Acute stomatitis

’•'Violent stomatitis and salivation

Violent stomatitis; deep mercurial ulcers on the inner surface of the right cheek descending as far as the tonsil; as the mouth healed she was attacked with fearful tremor, so that she could not leave her bed nor speak a word

Frightful stomatitis

Soreness and sense of swelling in mouth

Pimples and swelling in mouth (second day),V

A breaking out, similar to the ulcers in diphtheritis, upon the right side of the mucous membrane of the mouth and tongue; swelling of the right submaxillary glands, and profuse secretion of fetid saliva

* Ulcers in the mouth

In 1821, MM. F. and B., then students in the Hospital de la Pitie, and attending to the treatment of prostitutes, were both attacked with inflammation of the gums, which could only have arisen from the discharge of their duties in the venereal wards. In M. B.’s case, there were even ulcers in the back of the mouth ; they did not seem to him to be important, and he paid little attention to them until he perceived them to grow worse. He then consulted a distinguished practitioner, who pronounced the disease venereal, and prescribed a course of Mercury. As M. B. had never had syphilis, and had never been even exposed to the contagion, he declined to follow this advice. His complaint lasted several months, and disappeared finally after he had left off treating venereal patients. In the same year, M. P., another eleve externe at the same hospital, was likewise affected with a swelling of the gums, and also had ulcers on the mouth and back of the mouth, which, as fast as they were cured in one place, reappeared in another. He was finally relieved only by staying at home for some time

Numerous uleers in mouth

Ulcers on left margin of tongue and on right cheek

Ulcers on the mucous membrane of the cheek

Superficial ulcers in the angle in front of the arch of the palate, sometimes left, sometimes right

Deep ulcers developed on the inner surface of the lips and cheeks, with elevated, eroded margins, with swelling of the tonsils and cervical glands (after working fourteen days)

Inner surface of the cheeks deeply ulcerated and inflamed

On the mucous membrane of the lips were small whitish, deep, easily bleeding ulcers, with somewhat elevated margins, and of a livid color

Foul ulcers in mouth, from which a copious and most offensive sanious discharge was constantly dropping

Small pigmented scar on the right side, between the hard and soft palate, with a mercurial ulcer

Sciliva. Saliva increased Salivation,’’’’etc.; (third day)

Slight salivation (after nine days)

Long-continued slight degree of salivation

Moderate degree of salivation

Frequent salivation

An alarming illness broke out among the crews, all of whom were more or less salivated. The surgeons, pursers, and three petty officers, who were nearest the place where it was stowed, felt its effects the most, their heads and tongues having swelled to the most alarming degree. Every rat, mouse, and cockroach on board has been destroyed, and the symptoms of general salivation have appeared in a strong degree

Great salivation

Abundant salivation

Salivation very abundant; almost at its height (after eight days)

Profuse salivation

Very violent salivation

Salivation, which caused the loss of all his teeth

Thirty-nine out of the forty-three patients were attacked with mercurial salivation ; in some cases it assumed a severe form

Very offensive salivation

Ptyalism; has to spit a great deal (after thirty-eight years)

Ptyalism, which wasted her to a skeleton

Smoking caused unusually profuse salivation

Bloody saliva

Taste. Bad. taste

Bitter taste

Metallic taste

‘^Strong metallic taste (after thirty-eight years),™.

Unable to take soup, on account of a very salt taste which it seemed to have

Speech Speech treimdons,'^*; for years

Speech slow

Speech impeded,(second day)

Speech greatly impeded

Speech difficidt,^*; (after eight days)

Difficulty in speaking and masticating

Speech, difficult on account of the trembling of the mouth and tongue

* The masseter muscles became contracted, so that speech icas at times very difficult and almost impossible

Inability to speak plainly

Speech only partially intelligible

Speech scarcely intelligible

Could scarcely speak intelligibly, from the constant state of agitation into which they were thrown the moment they were addressed, or attempted to articulate,™.

Speech stammering,'’® ’* ”, etc.

Stammering (since the tremor began), (after thirty-eight years)

Speech stammering and usually very difficult

Speech stammering; at last unintelligible

Stammering, speech slow, difficult; entirely unable to speak on any excitement

Stammering like a child

Stammered badly

Dreadful stammering

Articulation somewhat indistinct (one)

* Difficult articulation, amounting to stammering; he coidd hardly be understood

Utterance embarrassed, indistinct, and hurried

* Psellis)mis (paresis tremens of the organs of speech)

Loss of speech

Throat p. 217

Chronic angina of the root of the palate, uvula, tonsils, and fauces

Sensation as of a foreign body sticking in the throat, seeming to be dependent upon involuntary contraction of the muscles of the pharynx

TJeala aH(1 Tonsils. *Soft palate, and especially the uvula, of a coppery-red color; on the left side, a long superficial ulcerfi.

Ulcers on the right side of the soft palate

* Great swelling of the 'uvrnfa

* Uvula elongated and enlarged

Tonsils red

Left tonsil greatly swollen

Tonsils much swollen and red, without patches (after nine days)

* Tonsils much enlarged (after eight days)

One of the meu who escaped the salivation suffered from acute tonsillitis

Traces and iPhari/nx. Mucous membrane of the fauces red, streaked with mucus

Angina faucium dark red

* Angina of the fauces of a coppery red color

Chronic angina of the fauces

Chronic angina of the fauces without ulceration

All the workers not salivated were affected with ulcers of the fauces

Constriction and dryness of fauces (after twenty minutes)

Circumscribed swelling of the pharyngeal mucous membrane

* Mucous membrane of the pharynx swollen in spots

Ulcers developed upon the posterior wall of the pharynx (after working a few weeks)

Suuallowin(f. Swallowing was convulsive, and often nearly caused suffocation

Great pain from swallowing or speaking

External Throat. Loud bruit de souffle in the veins of the neck, especially in the left side

* Lymphatic glands of the throat hard and rather large, bid those on the nape, elbows, and inguinal region not enlarged

* Submaxillary glands swollen

In some cases the submaxillary glands were swollen without salivation

Submaxillary glands slightly swollen (after nine days); (after ten days)

Submaxillary glands much swollen, especially left (after eight days)

Submaxillary glands slightly engorged

* Cervical glands swollen

Cervical glands swollen, soft

* Cervical glands very much swollen

* Cervical glands large, hard

Hard swelling of the cervical and parotid glands

Right side of the thyroid gland very much enlarged

Great hardness of the parotid gland, behind the ramus of the jaw,^h

* The right sublingual glands were as large as hazel tints, and very hard

Trembling of the sublingual glands

Stomach p. 218

Appetite. Loss of appetite,^^^"'^^, etc.

Want of appetite,’^-

His appetite fell off

No appetite

During the salivation, there was little appetite; when she had no salivation, she had ravenous hunger

Thirst. Thirst

Much thirst

Great thirst

Urgent thirst

Eructation amel Hiccomjh. Eructations, especially after eating

Violent eructations

Hiccough, that could not be quieted, aggravated by eating, with general weakness

Waasect and Vomitintj. Nausea

Distressing nausea

Vomiting

Vomiting of bile and food, with constipation, coated tongue, and great vertigo

Frequent vomiting of saliva and bile after eating

StOinach. Digestion disturbed

Difficult digestion

Pain and sensation of constriction in the epigastric region

Sensation of tightness and pain in the epigastrium

A contraction of the epigastrium, which increased during a sleepless night, with dyspnoea and hiccough, accompanied by cough, and followed by vomiting

Pressure in the stomach

Pressure in the stomach and eructations, especially after eating

Abdomen p. 218

Hypochondria. Twitching in muscles of right hypochondrium (after a few minutes)

* Chronic atrophy of the liver, xvith emaciation and desiccation of the body

One of the men who escaped the salivation suffered from chronic hepatitis

Subacute aching over hepatic region, preceded by acute aching in left wrist and dorsum of hand (second day)

General Abdomen. ^Abdomen greatly distended by gns

Abdomen tympanitic

Parietes of the abdomen tense

Abdominal muscles tense

Abdomen somewhat retracted

Pains in the abdominal muscles

Twitching pain in belly

Tearing pains in the abdominal muscles

Much colic

Flatulent colic, with constipation

aud Iliac Reyion. Griping in lower part of abdomen (after a few minutes)

Aching in right inguinal region (after two hours and a quarter)

Anas p. 218

Prolapsus ani

Stool p. 218

Eiarrhoca. Diarrhoea; in a few cases

Diarrhoea occurred to some simultaneously with the appearance of salivation

Diarrhoea alternating with constipation

Exhausting diarrhoea

Offensive diarrhoea

Diarrhoea thin, very offensive ; at times involuntary

Involuntary stools

Stools at first thin and green, but afterwards constipated

Flatulent motion, with softened, orange-yellow faeces (second morning)

* Bloody stools

Indolent stools (after two years)

Constipation. Stool constipated

Constipation ®’ ®®, etc.

Constipation, with occasional gripings; bowels opened every alternate day

Obstinate constipation

Bowels inclined to be costive

Bowels rather costive

Bowels would not act, nor could the costiveness in any way be relieved, and on the second day he died

Urinary Organs p. 218

Incontinence of urine

Urine scanty; specific gravity 1022,’®.

Urine scanty, dark-yellow, albuminous

Urine thin, frequently passed

Albuminuria with dropsical symptoms ; during pregnancy

Sexual Organs p. 218

3tale Total loss of sexual power

Female. Women frequently aborted

Profuse hsemorrhage from the female genitals

Sudden, profuse htemorrhage from the genital organs

Very profuse metrorrhagia; once there was menstrual flow for ten weeks

Menstruation irregular and scanty

Menstruation irregular, sometinrjes omitting, sometimes too copious, and too late

Menses scanty

Menstruation scanty, pale, lasting only a few hours

Suppression of menses

Respiratory Organs p. 219

Larynx and Bronchi. Complete picture of laryngeal phthisis, with erosions and ulcers on the posterior wall of the pharynx

One of the men who escaped the salivation suffered from chronic bronchitis

Dolce, Tone of voice altered (after eight days)

Voice tremulous, pretty much like that of a person during rigor

Conyh. Cough and tightness of the chest

Cough, with tightness of the chest

Cough, with pain in the left side and left shoulder

Cough, with profuse perspiration and great prostration, so that she kept her bed for a year

Cough at first dry, afterwards with white frothy expectoration, with emaciation and weakness

Loose cough, which finally was accompanied by such acute pain in the chest that leeches were applied in order to relieve it; the leechbites bled for upwards of twenty-four hours, and the blood seemed very thin

Cough, with expectoration, and so great emaciation that she was thought to have consumption

licspivation. *Fetid breath,'® ®*’*, etc.; (after thirty-eight years)

Mercurial odor of breath (after niue days)

Strong mercurial odor of the breath

While breathing quietly, respiration perfectly normal; but on attempting to take a deep breath, neither inspiration nor expiration was performed in one act, but in three or four jerks

Respiration rapid, accompanied by a sensation of constriction and by cough

Respiration very rapid

Respiration was frequently very weak, with dyspnoea, and even asthmatic attacks

Oppression of respiration, upward from diaphragm (after twenty minutes)

Very short of breath

Dyspnoea

Dyspnoea and cough

Asthma

Finally, became asthmatic; the paroxysms at first occurring with long intermissions, but gradually becoming more frequent; there was a constant rattling, but no cough or expectoration; towards the close of the disease, which lasted eighteen years, she could not walk or bend over, for fear of suffocation ; the symptoms becoming worse, she was confined to her arm-chair for more than a year before death came to her relief

Asphyxia

Chest p. 219

Object we. It was remarkable that in deep inspiration the diaphragm seemed scarcely moved

Tremors; after lasting six weeks they were followed by prof-^^e haemorrhage from the lungs at intervals for nearly three months; this disappeared after leaving off work, but reappeared on returning to it

The women who work in quicksilver are much more affected than the men, and a much larger proportion of them die; of the diseases with which the workers die, tuberculosis greatly preponderates, so that it seems settled that mercurialismus frequently passes into tuberculosis of the lungs, and there is no doubt that working in quicksilver produces pulmonary consumption

(One case developed tuberculosis of the right side of the chest, which progressed while the immediate symptoms of mercurial poisoning passed off)

* Emphysema of the lungs

Chronic emphysema of the lungs

Subjective. Pains in various parts of the chest, especially on deep inspiration

Tightness of the chest, and cough

Great tightness of the chest

Constriction of chest; lower lobes (diaphragm?), (after one hour and a half)

Severe constriction of the chest.

Constricting pains in various parts of the chest

Sensation of pressure upon the chest

Pressure upon the chest, without cough

Oppression of the chest

Lungs dreadfully oppressed

Pain in the left side, aggravated by inspiration

Heart and Pulse p. 220

I*rmcordium. Aching pain at apex of heart, extending upwards towards the base (pericardial)

Cardiac oppression (after one hour and a half)

Heart’S A^ctiOti, Palpitation

* Palpitation on the slightest exertion

Palpitation of the heart, with pulse that could not he counted

Frequent palpitation

Palpitation violent, irregular

False. Pulse full, tremulous, frequent

On retiring to bed quickened pulse (first night)

Pulse quick, weak, and small

Pulse quick and small, but difficult to be felt, on account of the constant tremor

Pulse small and rapid

Pulse slow

Pulse weak and slow

Pulse slow, 53 and 54

Pulse only 52 to 56 ; heart’s impulse very weak

Pulse weak, frequently slow, sometimes rapid and frequent

The pulse was slow, in many cases 50 to 56; in one 60, but showing great and rapid changes, running up to 80 or 100 on the slightest excitement

Pulse very slow in one case of ptyalism and weakness, but without tremors; and very small and slow in a case of tremors without ptyalism ; in other cases, the pulse was increased in frequency

Pulse rather weak

Pulse small, soft, aniemic

Pulse very soft

Neck and Back p. 220

iNeek. ’^Indurated lymphatics in the nape of the neck

Boring sensation in right side of neck (after a few minutes)

Tach. Softening and curvature of the spine

Periosteal aching down spine (after twenty minutes)

Twitching pain in back

Dorsal. Sensation of heat and hyperesthesia in upper half of back (after a few minutes)

Aching in mid-dorsal region to right of spine (after twenty minutes)

Right subscapular aching, becoming also interscapular, lasting two hours, at 11 A.M. (second day)

Right subscapular aching, extending over hepatic region, on waking (third day)

Continuous achings beneath lower angles of scapule, severe, continuing three-quarters of an hour (after one hour and a half)

Continuous aching beneath right scapula (after twenty minutes)

Long-continued severe interscapular aching (after twenty minutes)

Slight tenderness on pressure over the fourth and fifth dorsal vertebrae, but the rest of the spine exhibited no increase of sensibility

Throbbing over left acromion (after a few minutes)

Extremities in General p. 220

Ohjective. Caries, once in the elbow, once in the ankle

Loss of power in the limbs was accompanied by a certain hastiness of motion

* Tremor of the ® etc.

Trembling of the extremities, especially of the hands, so that the patient cannot hold them still for a moment, indeed, can carry nothing to the mouth

Tremor of the upper and lower limbs, which became worse when they were spoken to at all severely

Electric irritability was good, but the muscles of both the upper and lower extremities did not contract in a tonic manner but tremulously, so that the fingers upon the electrode felt a kind of whirring

Trembling of the hands and feet, so that the patient was unable to write

* Trembling of the hands, sometimes also of the feet

Periodic trembling of the extremities

Great trembling of the limbs

Trembling of the limbs so great that she could no more use her hands and could not ascend a height alone; she could only talk with difficulty, and sometimes could not at all carry the food to her mouth, and was even disturbed in bed by trembling, though it never amounted to convulsions; she could not hold light things in her hands, for the violent trembling would throw them away; but she was able to carry heavy articles

Excessive trembling in all the limbs, especially the upper; progressively increasing, until he was unable to work, or to eat, drink, or perform the offices of nature, without assistance,h

A woman had violent tremor of the extremities

Legs trembled moderately; arms violently ; had to be assisted in everything, like a child. So much difficulty in walking, that he often fell to the ground on his back, as if from some external force, even while striving to keep himself up by bending forwards

Quite unable to hold either hand steady for a moment; the muscles are wasted and thin, and always in a state of spasmodic activity; it is with the greatest difficulty that he can manage to feed himself; the affection is not so severe in the legs ; he walks very slowly, and with a tottering gait; he continued, however, to come upstairs without assistance, holding on by the banister all the way; in bed his movements are often sufficient to shake the bed

The principal affection under which he labored was not, as has sometimes been described in these cases, a constant tremor of the limbs and seesaw of the head, such as occur in old paralytic persons, but a sort of rapid convulsive agitation of the limbs (whenever the act of volition was exerted upon the muscles), which moved the extremities quickly in all directions except that which the will prompted. Thus, he could sit on his chair still and nearly unmoved, but the moment he got up and attempted to walk, his legs began to dance, as it were, in spite of himself, and performed very rapid and irregular motions, with so much violence as to compel him to drop on his chair again, or to throw him down. Somewhat similar motions were performed by his arms, if he attempted to use them; so that he was unable to carry anything to his mouth, and the smallest quantity of liquid was immediately dashed out of any vessel from which he made an attempt to drink. He was under the necessity, therefore, of being fed like a child. These spasmodic tremors were greatly increased by any circumstance that agitated his mind, or occasioned any anxiety (one)

They thought they were cured, when in about fifteen days after leaving off treatment, they were seized with jactitation of the muscles of the limbs

Sudden jerking of the extremities, so that he could scarcely walk or eat; the fear of falling induced him to keep his bed

Paralysis of the extremities except of the left arm; afterwards motion returned in the arm but not in the lower extremities

* Weakness of the limbs

Painful prostration in all the limbs (second day)

Subjective, Frequent falling asleep of the arms and legs, especially at night

Sensation of fuzziness and paralysis in the limbs

* Unusual heaviness of the limbs

Feeling of heaviness and fuzziness in the limbs

Feeling of heaviness in the extremities, especially feeling very sleepy, especially at night

Pain in the extremities

Pains in the arms and legs

Pains in the forearms and legs

Slight pain in the joints, especially of the wrists, elbows, knees, and ankles

Great pain and tremor in the limbs

Obstinate and intense pain in the limbs for a month

Dull pains in the joints

Returns of aching pains in limbs (second day)

Tearing in the limbs, especially in the arras

Tearing pains in the extremities

Painful tearings in the hands and feet, worse at night

Violent tearing pains, like rheumatism, in the arms and legs ; increased in bed, so that she was often obliged to leave it

Superior Extremities p. 221

Objective, Trembling of the arms

Suddenly seized, after a day of unusually laborious work, with cramps in the fingers, which were shortly followed by a shaking and tremulous motion of both upper extremities. They were slight at first, but gradually increased, so as to become very distressing. This agitation of the muscles continued even during sleep, and was accompanied with a gnawing pain, as he expressed it (after two weeks). The symptoms have become still more general, the lower extremities having been affected the previous evening, so that, in fact, the whole body appeared in constant motion. Towards the latter part of the day, the tremulous motion of the muscles of the right arm subsided, but the limbs remained almost paralyzed (after three weeks)

Entire loss of control of the left upper extremity; all the limbs were more or less affected

The left arm cannot be raised ; the forearm is moved with difficulty, the hand more easily, while the fingers are perfectly flexible; right arm similarly affected, but in a less degree; the right hand can be lifted to the chin

Paresis of the right upper extremity, with trembling

Subjective. At times, a disturbance of sensibility in the left arm

Rheumatic pains in the arms

Rheumatic pains in the left arm

Drawing pains in the arms and hands

Tearing pains in the left arm

Much soreness in the muscles of the arms

Periosteal aching in outer side of left arm, changing to left wrist and forearm, on waking and subsequently (second morning)

Fovearm. Patients are subject to cramps and paralysis of the extensor muscles of the forearm,’®.t

Achings in flexor muscles of left forearm (after two hours and a quarter)

Periosteal aching down left forearm ; then down right forearm; then in right elbow; then down spine; with varying intensities (after twenty minutes)

Constantly repeated, prolonged convulsive movement of both forearms on the radial side, causing flexion of the thumb and forefinger

[^30.] First symptom was weakness of the forearm and pain of the elbows

Wrist, Wrists permanently flexed at a right angle with the forearm, but are easily straightened out

Acute aching in left wrist and dorsum of hand, succeeded by subacute aching over hepatic region (second day)

Hand. As soon as they were desired to do anything with their hands, it was evident that they had no power of directing them with decision to the performance of voluntary motion ; thus, instead of taking hold of a book or paper presented to them, they caught at it with sudden spasmodic jerks; and whenever at last the paper was seized it was crumpled in the hand

* Tremor of hands

Trembling oj the hands, so that it became impossible to hold anything, with great weakness

Trembling of the hands, at first lasting about a quarter of an hour, and passing off, afterwards becoming more and more frequent, and lasting a longer time

* Hands trembled so that he could scarcely work

* Constant trembling of the hands, so that the patient cannot hold them still for a moment, and every movement is impeded thereby

Involuntary trembling of the hands

* He could neither feed nor dress himself

* One could not carry a glass of water to the mouth without spilling it; coidd take neither food nor drink, but had to be fed like a child

* *S'o paralytic that he could not, with both his hands, carry a glass half full of wine to his mouth without spilling it

Frequent involuntary jerking of the hands and fingers; the convulsions are greatly aggravated by every exertion

A slight loss of power in the hands, which came on at various times, and was generally relieved by the use of ardent spirits

He was in the habit of intoxication; and noticed that when in this state he could hold his glass without spilling, which he could not do when sober

Fingers. Finger nails blue

Trembling of the fingers

The fingers of the left hand became permanently contracted

Sensation of coldness and deadness of the fingers

Inferior Extremities p. 223

Considerable oedema of lower extremities (while the eruption was going off)/

Veins of the lower extremities dilated

Varicose veins in the legs/®

Varicose veins of the legs, without ulcers

Saphena vein as large as the thumb

Trembling of the legs, so that he could scarcely stand or walk, with trembling of the hands, so that he could carry nothing to his mouth, and trembling of the tongue

Movements of the lower limbs were performed naturally, hut slowly ; those of the hip-joint were difficult

Gait in walking uneven and hesitating (younger)

His walk was hesitating and difficult

Remarkable heaviness of the lower extremities, so that the gait was unsteady, followed by tremors of the hands, and gradually of the whole body

Staggering gait

Patients suffering from mercurial tremors had a gait very similar to those suffering from tabes dorsalis

Unable to stand steadily

Great weakness of the legs, so that he could scarcely stand

Confined to his chair; unable to walk a step

Bursting sensation in right leg, followed by periosteal tingling (after a few minutes)

Although every muscle of their legs was trembling, they were frequently obliged to stretch them out upon chairs, in order to relieve the severe cramps in those parts

Periosteal aching in anterior surface of left tibia (second morning)

Pains in the knees at times

Soles of both feet turned inwards and upwards; the tendon of the tibialis anticus is rigid and prominent; this contraction is permanent and painless

Tingling of toes (left foot), (after a few minutes)

Gviieral Sumptonis.

Ohjective. Emaciation,^^

He was emaciated and cachectic, and looked prematurely old

Considerable emaciation (after thirty-eight years)

Great emaciation

Excessive emaciation

Body wasted

Cachectic condition

It is certain that the children of the workers are affected Avith the mercurial poisoning; although it may be from the poison carried in the clothing;,'®.

One child of a Avoman-worker Avas badly nourished, and Avhen a year old had no teeth

The children of the Workers Averse pale, cachectic, and scrofulous; Awhile, in the same locality, the children of those Avho did not AAork at shivering mirrors were usually healthy

The children of the Workers are very commonly affected by scrofula, rachitis, and tuberculosis

Her child had the rickets

A daughter, born during her mercurialismus, AA^as A^ery small, only learned to Aval Avhen three years old, and never great to be more than four feet in height; there Avas kyphoskoliotic curvature of the spine, the head Avas draAvu to the chest and some- Avhat to the left side; there Avas Aery imperfect development of the muscle and bone

This Avorker had four children by his first Avine, who Avas also employed in the factory; all Averse sickly; one son died of gangrene of both feet; the three other children and the Avine died of consumption ; the second wife and her children also died of consumption ; the children of the third Avine Averse healthy, except the one born after she AAas employed in the Avorks; all three Avives died in consumption ; of the first Avife’s children one Avas thirty-one years old, the second twelve, and the third three or four years

A child of one of the Workers, a year old, had trembling of the arms, moderate stomatitis, and ptyalism ; the child AAas pale, but Avell nourished, even fat, and intelligent

Fatal consumption

One Avoman, Avho had been healthy and had three healthy children, died of tuberculosis

Chlorosis and amenorrhoea, palpitation, Weakness, loss of appetite

Chlorosis; skin of the face and mucous membrane pale, Avhite like a corpse, eyes watery, pulse small, rapid, great thirst, palpitation, dyspnoea, pains in the head and stomach, oedema of the lower extremities, general weakness, depressed mood, blowing sounds in the carotids

Exostoses, especially on the tibia, seldom on the upper arm or head ; these were accompanied by swelling and sensitiveness of the periosteum, especially aggravated at night, and by the warmth of the bed and in cold damp weather, thunderstorms, etc.,^®.

Periostitis and subsequent necrosis

Araong-five hundred patients suffering from caries, necrosis, or exostosis of the bones, there is no case known of it occurring among the workers in Mercury,'®

Syphilis was extremely rare among the workers

Syphilis is extremely rare among the workers in Mercury, especially remarkable since the sexual desire is usually excited ; several physicians who practiced in Fourth, where the factories are, aud who had a large practice among syphilitics, could not remember a single case of syphilis among the workers

Syphilis is exceedingly rare; but one case was treated by Prof. Thiery, in Brussels; a man, suffering from mercurial poisoning, tremors, salivation, etc., had an indurated chancre with swelling of the inguinal glands, but developed no other symptoms of constitutional syphilis so long as he was under observation ; within thirty years, more than two hundred persons in Erlangen, and four or five times as many in Fourth, have been treated for constitutional mercurial poison; and though these cases have increased sexual desire in consequence of Mercury, and, without doubt, are not particular about their associations, since among them the belief is universal that Mercury protects them from syphilis, no case has been known to occur. Cazenave has never seen secondary symptoms among the workers

No case of syphilis was ever known to occur among the workers, though they were no more continent than other people

The caries affects the bones and joints that are never or rarely affected by syphilis ; among five hundred aud sixty workers in Mercury, there was not a single case of caries of the scalp, tibia, clavicle, or sternum, which parts are especially affected by syphilis

When the system begins to evince that it is under the control of the medicine, various symptoms are exhibited ; sometimes they are of a mild nature, at others very violent; the mouth sometimes first displays the constitutional affection, but it is most generally preceded by some degree of acceleration of the pulse, a degree of feverish excitement, and various nervous affections. If the ptyalism be suddenly established without much previous admonition, the excitability of the system is very commonly much greater, aud general constitutional disorder is evinced, aud the soreness of the mouth causes an irritability of the whole frame; considerable absorption of the fatty matter, attended by a great attenuation of the body, is quickly visible, and the stoutest person generally becomes thin and emaciated; the excretions from the various organs are altered in appearance, and, oftentimes, in odor; the alvine evacuations become of a brighter yellow, the urine is higher colored; a peculiar state of the skin, evinced by a very singular fetor, which is quite diagnostic of the mercurialization, and of which it is impossible to convey any impression by language. It materially differs from the smell that issues from the body after sweating has been produced by Dover’s powder, or that which occurs after some eruptive fevers, or upon mental derangement; it is a peculiar characteristic which occasionally lasts after ptyalism ceases. When the action is very severe upon the mouth, the misery which taking any food produces is enough to prevent the indulgence of the appetite, which is sometimes not at all diminished; but when the ptyalism has completely ceased, the appetite is of the most ravenous character, which nothing appears to satisfy; then nutrition recommences, the depositions of the well-digested secretions in the various parts of the body, which have lately lost their usual quantity of fatty matter, is very rapid, and the frame speedily acquires even a greater bulk than it previously had, and oftentimes the standard of health is more firmly fixed than it was before; hut this is not always the case ; some individuals are left in a state of great feebleness, and liable to every shock that would, under ordinary circumstances, be light. Sometimes local disease has lasted for some time, and even run to a very outrageous extent; ulcerations of the tongue, exfoliations of the alveolar process,*h

The first symptom was persistent diarrhoea, which lasted profusely eight days, and ceased after she stopped work; after a year and a half there appeared tremors with loss of appetite and diarrhoea, followed by falling out of the hair; on stopping work and using baths the tremors disappeared in four weeks, and the hair grew again ; after returning to work the teeth began to be gray, though she daily scoured them with charcoal; afterwards she was attacked with weakness, vertigo, uneasy sleep with heavy dreams, loss of meraoiy, affections of the mouth, which she treated with alum, and increased decay of the teeth; after a time the tremors reappeared and gradually became worse, as also did the headache and sleepiness; afterwards she had palpitation of the heart and hiccough, at times so violent that she had to be held by several people; after leaving the work she became better, but the tremors did not entirely leave her, and were especially aggravated by any vexation or other emotional excitement; the gums wei’e somewhat atrophied and retracted from the teeth; teeth of a grayish-brown color; copper color of the roof of the palate and uvula; slight tremors of the extremities and of the tongue, especially noticeable in speech; the right posterior cervical gland swollen; rheumatic pains in both upper arms ; profuse perspiration at night and easily becoming chilly; the patient had had two children, the first four weeks too early; the child was weak, and died when a year and a half old

One day when he was getting better I met him suddenly in the street; he suddenly became very much affected, staggered, could scarcely speak, and nearly fell down; pulse 120, small; respiration rapid, with violent trembling; after keeping quiet for half an hour the trembling disappeared and he was able to speak; pulse 80; complained of great weakness of the limbs and oppression of breath, especially at night

* Breath and whole body smelled food

* Peeidiar hastiness of all motions

* Involuntary motions of the head and hands

The arms and especially the hands, when kept in a horizontal position, are soon thrown into a constant jerking movement. This is independent of the will, and the patient is not only unable to stop it, but it even becomes more frequent when she tries to restrain it; and slight emotional disturbance has the same effect. All manual labor, all prehensile movements of any delicacy, are nearly impossible; she can hardly pick up a needle lying on a table. The lower extremities are similarly affected ; she can scarcely stand; walking is difficult and staggering; she has to support herself every moment (after thirty-eight years),™.

* Trembling

General tremors

* Involuntary tremors

* General involuntary tremor

* Mercurial tremors affect the muscles which are usually under the control of the will, so that one is never master of his own motions ; the affected muscles exhibit normal electrical irritability, but are not able to respond to the will; on attempting to respond the muscles begin to tremble and twitch excessively; they frequently make all sorts of motions, as in chorea, before the desired motion is effected, or are sometimes affected with violent convulsive motions, which also involve neighboring groups of muscles; these muscles are better able to hold heavy objects than light ones, as for example, a knife or fork cannot be used because they are jerked out of the hand, while a heavy object may be held firmly for a long time; the hands and arms are first affected, the lower extremities next, while the head becomes affected later and only in violent cases; the general trembling of the body seems to alternate with the stammering of speech ; sometimes the speech is very stammering and unintelligible, while the rest of the body is not affected; at other times the whole body trembles, twitches immoderately, while the speech though tremulous and interrupted is yet intelligible; sometimes one-half of the body is more affected than the other; sometimes the patients are unable to walk, drink, eat, dress, undress, speak intelligibly, or indeed to utter an articulate sound ; sometimes patients are able to ascend and descend steps, though with difficulty, like patients with tabes dorsalis, but are not able to eat or drink, while in others these conditions are reversed; some are no longer able to drink without assistance because the water is spilled before it reaches the mouth, while they are still able to carry food to the mouth by supporting the arm ; one patient was obliged to be held by several people whenever he attempted to drink; sometimes chewing is absolutely impossible; in the convulsive form patients are obliged to be tied in bed to prevent their being thrown out by the convulsions. At times tremors occur in paroxysms of varying severity and duration ; these paroxysms are brought on by emotional excitement, physical exertion, and sometimes occur without assignable cause. At times the paroxysms resemble the violent shaking of ague. One case presented the following remarkable symptoms: the whole body was tossed to and fro, while every muscle and each group of muscles seemed to be in incessant activity; the head rolled about on the shoulders, jerking backward and forward and from side to side, the eyelids opened and closed, the eyeballs rolled from side to side, the wings of the nose and the corners of the mouth twitched, grimaces distorted the face, the jaw moved backward and forward, the upper and lower extremities jerked as a whole and each muscle by itself; the convulsions were even so violent that several strong men were unable to hold the patient; it tossed him to and fro or threw him out of bed. In another case the patient suffered from general tremors with stammering, at times amounting to most violent convulsions, in which she screamed loud, and had to be bound, consciousness, however, was not completely lost; the paroxysms seemed to be worse in the evening, and only in very violent cases did the trembling continue during sleep; the tremors usually prevent sleep, or as soon as the patient falls asleep a convulsive shock wakes him, and the tremor begins anew (tetanic spasms have neverbeen observed)

Altogether disabled from work by paralytic tremor and debility

Trembling not only of the limbs but of the whole body, of the tongue when protruded; speech was stammering

General convulsive tremors; his arms and head trembled even while sitting; speech was tremulous; the tongue trembled when protruded; all the muscles of the body gradually became affected, and all in constant motion; the head, arms, etc., were never quiet for a moment; the eyelids twitched as if affected by chorea; constant twitching of the muscles of the face; sometimes for a moment there were more violent tremors of the right half of the body, amounting to clonic convulsions affecting one or several groups of muscles and certain fibres, as for example, of the pectoralis major, were at times affected by violent shaking; speech difficult, stammering; he spoke only short syllables; it was frequently impossible to pronounce these ; the patient was so weak and dizzy that he could not leave the bed

The limbs tottered, and the man, though young, moved like one advanced in years. He could not convey any liquid to his mouth in consequence of the severity and constancy of the tremors. So great was the violence of the trembling of his whole frame that he was nearly thrown out of a bath by it; much of the water was driven over the side of the tub, and it required the force of two men to prevent him from being actually ejected

Tremor, beginning in the hands, and soon becoming general

Trembling of the hands, afterwards of the extremities, and gradually of the whole body

This was his third attack of tremor, the first having occurred seven years ago. Now affected with general tremor, the head being involved as well as the limbs, and the arms so much agitated that he could not cut up his dinner. At first he used to shake most at night. His spirits were greatly depressed by the attack. Felt dreadfully nervous at times, especially during change of weather

The symptoms first experienced were unusual nervousness and trembling of the hands, as well as tremor when standing; and this rapidly increased, so that he was unable to feed himself. At the time I first saw him, he stated that he was infinitely more steady than he had been a few months before, but still he had tremor (jf every part, and difficulty of speaking ; and the more he was questioned about his ailments, the more agitated he became, till he was quite unable to stand, to assist himself, or to speak

* General tremors, with stammering of speech, most violent convulsions at times, during which the patient scarcely ever completely lost consciousness; relieved by tightly binding the body and limbs

Formication, drawing pain, and a fuzzy feeling in the upper extremities, followed by trembling, first in the upper, then also in the lower extremities, and at last of all the voluntary muscles, so that she could neither stand, walk, speak, nor chew; this trembling was aggravated on every attempt at voluntary motion and by emotional excitement

General tremor. Almost the whole locomotive apparatus was shaken by regular and spasmodic vibrations, apparently caused by alternate muscular relaxation and contraction. The tremor was more marked in the upper than the lower limbs, and on the left than on the right side. It became worse when the patient attempted certain movements, especially if of a tonic character; and these became more disordered in proportion as they required precision and voluntary effort. Walking was difficult and hesitating. Eating and dressing without assistance, and, a fortiori, legible writing, were impossible. The abnormal muscular action extended to the oi-gaus of speech, causing a precipitate and indistinct mode of utterance, which did not, however, amount to stammering

The tremor chiefly affected the limbs, especially the thighs, legs, and forearms. The dorsal and gluteal muscles, and those of the pelvis and shoulder were less affected

those of the upper abdomen, anterior chest, and face, not at all

When laboring under one of his numerous attacks of convulsive trembling, he was liable to break whatever he touched, and the movements of his legs were so irregular that in going downstairs he was sometimes obliged to jump over two or three steps at once ; to avoid this, he was in the habit of crawling backwards, and on his hands; he drank out of a dish, in order to bring the liquid more readily to his mouth, and because a glass would be crushed by the spasmodic clenching of his jaws

Tremors, always commencing in the fingers, gradually increasing in violence and extending until the whole body was involved

Trembling of the corners of the mouth, tongue, and hands

Tremor of neck and hands

Tremors beginning in the hands, especially when attempting to hold anything, gradually increasing, attacking the knees, and rarely the neck

Trembling of the extremities and head

Tremors first attack the fingers, arms, and then the knees, extremities, and tongue

* Tr8bling of the hands and tongue

* Tremor of the hands, so that he could not lift anything, eat, or write; marked tremor of the neck and lower extremities

Trembling, which disabled him from writing, drawing, or working, and even from eating or drinking without assistance

Had to be assisted in everything like a child

Tremors so that she could not drink without assistance

Trembled so badly that he could do no work, and could not go upstairs without great danger of falling ; had to be fed. dressed, and assisted in every other way like a child; could not go out of doors for three months ; and, when the weather became warmer, began to creep rather than walk about the streets

Sudden tremors

Tremors occurred suddenly and unexpectedly, amounting to frightful convulsions, which throw her out of bed if she did not have tight hold of something; was obliged to be fed; speech entirely lost

The attack is sometimes sudden, at others gradual ; with unsteadiness and shaking of the arms and limbs, which prevent walking, speaking, or masticating; for the tremors become frequent, nay, almost constant; every action is performed by starts; if the occupation be continued, sleeplessness, loss of memory, and death terminate the scene; a peculiar brownish hue of the whole body and dry skin generally accompany the disease. In its first attack it may be taken for St. Vitus’s dance, in its later stages for delirium tremens

Very great tremors

Violent tremors, so that she was obliged to lie down

Violent tremors, with jerking of the hands, feet, and head (rats and mice inhabiting the mines became affected with tremors and convulsions, like men),V

Violent tremor, which at times made it impossible for her to take food or work

Violent trembling, first of the hands, afterwards of the whole body. Shaken by continual spasms; he could not speak, nor could he carry his hand to his mouth without striking himself, he was obliged to be fed

Tremor very violent; especially on any excitement, preventing speech

Such violent general trembling that she was confined to her bed for nine months, when she was frightened out of it by an alarm of fire, which endowed her with momentary strength

A sudden violent attack of tremor, without vertigo, so violent that speech was difficult and he was obliged to keep his bed

Frightful tremors, with inability to speak, take food, etc., accompanied by sleepiness, with stupefaction, vertigo, starting up, violent headache, great weakness of memory, great anxiety, tightness of the chest, Roaring in the ears, flickering before the eyes, constant motion of the eyeballs, and bends of the limbs

Frightful convulsive tremors, with unintelligible speech, inability to walk, violent attacks of vertigo; the tremors prevented sleep

Trembling at first came on at long intervals; but finally, after a feverish attack that lasted five days, it became continuous, and so bad that he could neither talk, work, nor eat

Tremors in paroxysms almost daily, often several times a day, generally worse in the morning than in the evening ; these paroxysms interfered with his work ; they often occurred spontaneously without knowm cause, but were especially violent after emotional excitement; the whole body and head trembled violently; he could scarcely stand upon his limbs; it was difficult to speak; he was like a man shaking with the most violent chill, only there was no cyanosis

Tremors aggravated by emotional excitement

Tremors recurred for years from any emotional excitement

During rest the patient did not tremble, but on the slightest emotional excitement, even when spoken to, there was trembling of the arms, legs, and head, so that she was obliged to sit down, and the pulse became accelerated

When the women were asked why they did not speak they, almost without exception, answered that the visit frightened them; excitement seemed to cause trembling

Tremor, not constant, but especially noticed when under the influence of surprise or fear,k

Every attempt at voluntary motion increased the tremors

On every attempt to exercise the voluntary muscles, the tremors take place

In general, so long as he does not attempt the performance of an act of volition, the muscles are not agitated, but on attempting any motion the tremors and jactitation occur

Trembling after standing or walking a long time, disappearing during rest

Tremors, not during rest, but on attempting to make any muscular exertion, except of the neck and face; the tremors lasted as long as the muscles were exercised, when they also extended to the groups of muscles not in motion; so the outstretched hand trembled ; especially on stretching out the fingers and on repeated pronation and supination of the arm the whole body trembled; the protruded tongue trembled very violently. All the muscles reacted completely to the galvanic current

Awhile walking and standing, the trembling is not so marked, but as soon as the patient closes the eyes the trembling becomes much worse, when it is noticed even in the feet

Trembling of the muscles of the head and spine, so that on account of the general tremors can neither stand nor sit on a chair without danger of falling; the tremors ceased only while asleep in bed

Those suffering from salivation rarely had tremors

Tremors alternating with violent general convulsions

Shaking palsy, which lasted all his life

General clonic spasms of all the muscles of the body, ushered in by violent spasmodic pains; the paroxysm was so violent and accompanied with so much raving that the patient was placed in the delirious ward; after a year, a second similar attack occurred ; the consciousness was never lost, the tongue never bitten; the attacks were preceded by vertigo and confusion of the head,™.

Violent spasmodic affection. The head, arms, and fingers, particularly on the left side, presented a succession of quick, convulsive, jerking motions. The angles of the mouth were retracted, the eyebrows twitching, the head constantly thrown back, but the agitation scarcely raised the arms. The nostrils were spasmodically dilated. The sterno-mastoid, trapezius, scaleni, diaphragm, and the abdominal muscles were similarly affected. Their contractions were short, rapid, and painful. From the constant hiccough with which the spasms of the diaphragm were attended, and the jerking motion of the tongue, his speech was interrupted and indistinct. He was occasionally free from spasms altogether, but whenever he transmitted volition to any part of the muscular system, it became instantly affected. When he endeavored to raise his foot from the ground it quivered and fell quite powerless and useless. Whenever he attempted to carry a vessel to his lips he generally overshot the mark, carrying the vessel towards his ear, nose, or forehead, and spilling its contents on his face or neck, so that it was a common saying among the patients in the ward, that he did not know the way to his mouth. But if a vessel was applied to his lips by another person, he could swallow easily. A sudden blast of cold air, the application of a cold hand to the skin, or the abrupt entrance of any person into the ward brought on an attack of spasms. The muscles of the left hand and left side were affected much more than those of the right. After a few days, the spasms of the left side continued, though much less severe. Those of the 2)urely voluntary muscles of the right ceased, while the s2)arms continued in the respiratory muscles on this side/®.

Irregular and gradually increasing spasmodic action, affecting more particularly the hands, which were in almost constant motion ; the left was most convulsed, and the moment he was spoken to the convulsive action increased. If he attempted to make any voluntary exertion, as taking hold of anything, the hand was thrown in every direction with short but violent convulsive catches. When lying quite undisturbed, the motion was often for a time suspended ; he had also a hurried, convulsive, and indistinct mode of articulation

Frightful convulsive spasms; inability to speak or leave the bed, with great anxiety and roaring in the ears

Paralysis

All, sooner or later, became paralytic and die hectic

Died with symptoms of apoplexy, one side and the tongue being paralyzed

Decay of the bodily and mental powers went on unceasingly

* Weakness,'®“ ®', etc.

A child born during the mercurial disease was weak, had to be fed because the mother had no milk, and died after seven weeks; this woman afterwards had eleven confinements but only five living children

* Great weaJcness

* General weakness, approaching to palsy

General weakness, at first affecting the left and afterwards the right arm, weariness, with general tremors increasing very rapidly, so that she was obliged to keep her bed ; this was followed by violent pains and cramps in the right arm that lasted three days, followed by complete paralysis; for this weakness the patient was kept in bed; this was associated with g?-eat mental weakness, hallucinations, delirium, aphonia, and almost complete blindness and loss of hair; her mind returned slowly and gradually, and her right arm regained a portion of its former power, but was never strong; after some years the arm was emaciated and at times affected by violent tremors; sensibility was perfectly acute; the slightest touch or the prick of a pin was instantly felt, and followed by reflex motion, and the muscles reacted perfectly to electrical stimulus

Sudden attacks of weakness and trembling

Progressive weakness, until the patient is no longer able to walk

Weakness that increased so that he was unable to walk about the room alone; was constantly obliged to keep his bed

Debility, at first of the lower limbs, afterwards affecting the arms and hands, then becoming general, and soon succeeded by visible tremor (after eighteen years)

Much debility

Enfeebled

General exhaustion

Collapse; with swelling of the gum, fetid breath, hiccough, agrypnia, retention of urine

Some were obliged to sit or lie the whole day, and on attempting to stand they fell to the ground

Attacks of faintness, during which she did not entirely lose consciousness, accompanied by a peculiar distressing sensation in the right hypochondriac region (after some years)

Three attacks of faintness in one day; the first was caused by starting at something falling to the floor

Restless, noisy (younger)

* A universal uneasiness of body, so that he could not remain one moment in the same posture

Subjective. General bodily torpor

General anaesthesia, with a sensation of numbness and fuzziness, especially of the fingers

Cutaneous sensibility more obtuse in the limbs than in the trunk, and in the right lower extremity than in the left

Diminution of the sense of touch

The sense of touch became blunted

General state of troublesome excitement

Very easily startled

Startled and flurried by slight causes (one)

General sense of great debility (one)

Painfulness of the affected parts

All affected parts painful (after nine days)

All affected parts very painful (after eight days)

* Bone-pains

Pain in head and bowels

Much pain in limbs and loins (one)

Severe pain all over, worse at night/

Wandering pains

Rheumatic troubles

Rheumatic pains, especially in shoulders and forearms

Drawing in the bones

Nightly drawing pains in the head and extremities

Shooting pains and a sense of formication in various parts of the body

Tearing pains in the face, head and neck sometimes accompanied the stomatitis

Young people are more easily affected than old

Skin p. 231

Earthy color of skin (after thirty-eight years)

Skin pale, soft

Skin pale, dry

The skin on the back of the hands was thin and glistening

So full of Mercury, that putting a piece of brass in his mouth, or rubbing it in his fingers, it immediately became white like silver, as if he had rubbed Mercury upon it

Very great desquamation of the thickened epidermis of both legs; the scales are rather red ; under them the skin has a dark-red pigmented look; formerly there had been numerous small ulcers on the legs, followed by this desquamation

Fresh wounds healed very slowly

EruptioiiSf Dri/. Papular eruption

Feverish, eruptive exanthem resembling roseola, which began first in the throat and face, and from these parts spread all over the body (five or six days after appearance of other symptoms); in six days it disappeared without leaving any trace

Papulous exanthema over the whole body, with nightly bone-pains

Maculosus, papulous, or even squamous eruptions; the latter especially in old people (on the chest, back, and scalp) ; these eruptions often appeared suddenly, lasted a few weeks and then disappeared, and then again returned

Psoriasis in spots over the whole body,*®.t

Urticaria on the genitals and thighs, and in spots on the chest and abdomen, lasting two days,*®

An itching and redness between the fingers, also a swelling of the face, and especially of the inner side of the elbow; with a somewhat altered state of bodily feeling, and a sense of loathing. On one occasion, a letter was brought to me by a countryman, who had carried it in his bosom, next to an undergarment which he had besmeared with mercurial ointment for the destruction of lice. Scarcely had he produced it, before a swelling bigger than a hen’s egg appeared on my hand, and my face puffed up and became red and itching

EriiptioilSf 3Toist, *It is an erythema, upon which vesicles form, and pour out a thinnish, clear fluid. The vesicles are quickly broken, the contents desiccate, and the redness remains for a week or ten days. (It is clearly a local disease, and not a true eczema)

Groins and thighs very itchy and painful, with eruption on thighs (after ten days). Very copious red eruption and general erythema all over the thighs. Eruption slightly elevated above skin and somewhat rough to touch. It extended pretty generally over lower extremities, and had also appeared on arms and hands. In some places, small vesicles (after twelve days). Erythema has extended over arms, and the eruption over greater part of body. An exudation of a serous, yellowish fluid has also tak^n place, particularly from the inside of his thighs, groins, and contiguous parts, which, when dry, stiffens his linen (after fourteen days). In a few days, the erythema had extended over the whole skin, which was everywhere very painful, somewhat swelled, and most distressingly itchy, attended with a considerable desquamation of the cuticle. The exudation became more general, frequent, and copious; the smell which issued from him was peculiar and very offensive. Cuticle begins to come off in large portions. The discharge is attended with a most unpleasant and peculiar odor. Trunk of body and extremities, particularly feet, considerably swelled (after twenty-two days). Exudation more general and copious than it has yet been, attended with much itching. Smell from discharge still more offensive (after twenty-three days). Swelling of face so considerable this morning when he awoke, as nearly to close his eyes. The cuticle is falling off in portions of very considerable size, especially from his hands. Feet still more swelled, and of a deeper red color (after twenty-four days). Erythema continues almost general, the pain and itching very distressing, the exudation very profuse, and the fetor exceedingly offensive. Lips and eyelids more swelled ; tarsi and eyes considerably inflamed (after twenty-five days). The exudation which had taken place on the forepart of the breast, belly, and extremities, is also coming from his face to-day, which is more swelled, and there is considerable desquamation from his shoulders and back (after twenty-six days). Copious exudation from the breast. Considerable desquamation from the face (after twenty-seven days). Exudation very general. Desquamation begins to extend to hairy scalp (after twenty-eight days). Back very itchy, as usual before the exudations, which, however, have been rather less frequent for several days; but his skin continues very painful, the fetor very strong, and large portions of the cuticle are falling off (after thirty days). Some swelling in many places where the cuticle had peeled off. The newly formed cuticle cracked during the night, and a considerable exudation succeeded (after thirty-two days). Exudation diminished ; but skin still very painful, and feet and hands much swelled (after thirty-four days). Exudation again more profuse (after thirty-six days). Exudation very profuse (after thirty-eight days). Swelling of hands nearly gone; that of feet continues, and the newly formed cuticle is coming off lower extremities in pretty large portions (after thirty-nine days). Exudation much diminished (after forty-four days). Exudation nearly gone except from back of head; but skin still itching, and very painful, especially when he moves; feels as if his flesh was cracking in pieces (after fortyseventh days). Skin more painful (after forty-eight days). Some exudation for last two days, with restless nights (after fifty days). Less pain and itchiness of skin to-day, but some exudation (after fifty-one days). Some flushing of face, and increased redness of trunk and extremities. Some exudation from different parts (after fifty-two days). Redness of trunk and extremities; pain and itchiness diminished. Exudation more general, and there is a discharge of purulent matter from his hands (after fifty-four days). Exudation chiefly from back (after fifty-six days). State of skin still occasions considerable uneasiness; some exudation from back of head, from which the hair is falling off (after fifty-seven days). Two small tumors, one on left breast towards sternum, the other on lumbar region of same side, which seem to contain a fluid, and are ^f a darker color than the rest of skin, but are very little painful (after fifty-nine days). Skin much better, itchiness much less troublesome, and smell much less offensive (after sixty days). Feet very tender (after eighty-three days). The soles of the feet continued so tender for many weeks, that he could hardly put them to the ground ; on which account, he remained in the hospital for a considerable time after he was quite well in every other respect

Whole surface of body hot and itching, with swelling and inflammation of the integuments, most considerable on face and eyelids. These symptoms were preceded and accompanied with alternate cold and hot fits, languor, prostration of strength, loss of appetite, thirst, and watchfulness. She continued in this state for fourteen days, when a scarlet eruption appeared over the whole cuticle, particularly on inside of arms, thighs, and legs ; attended with an exudation, which was greatest from the groins and thighs, and with a disagreeable smell. In a few days, the eruption became dry and white; and afterwards the cuticle peeling oft', and leaving the cutis very itching and tender, the new cutis became affected in the same way as the former,*'h

Eruption of many large sudaraina on abdomen, chest, and upper limbs. They first appeared as round, transparent vesicles, varying in diameter from half a line to two lines, and with a red areola. These were filled with a clear liquid, excepting on the abdomen, where it was slightly turbid. Under the lower jaw were shreds of epidermis, caused by the desquamation of some of these vesicles. On the third day, several of the sudamina had dried up, and new ones had appeared; on some portions of the chest and abdomen the desquamation took place in patches, owing to the coalescence of the swellings. On the sixth day, there were more new sudamina; and on the eighth day, thirty-six hours after death, many were still to be seen, containing a transparent liquid, and in all respects similar to the preceding

Erysipelas of the forearm; of the legs

Eczema on the back, appearing in the form of vesicles as large as the head of a pin, with violent itching

Eczema on the back of the foot

Herpes oris

Mercurial sores are not necessarily circular or oval in shape, neither are their edges regularly defined; on the contrary they vaiy in these particulars, and assume different forms as they spread ; their edges are often quite ragged, loose, and undermined, and their borders are often marked with a thin, transparent cuticle, like that of a newly formed cicatrix, extending quite around them, and giving them a silvery-white appearance ; their bases are not hard, neither are their surfaces covered with the tenaciously adherent lymph so characteristic of venereal; on the contrary the surface of the mercurial ulcer may present every variety of. shape and appearance, sloughy at one spot, deeply excavated and rapidly ulcerating at another, with exuberant granulations at a third, and exhibiting a tendency to heal at a fourth. But the most striking characteristic of the mercurial ulcer is its tendency to spread, and the manner in which it enlarges itself; it generally spreads quickly, and there seems to be no limit to the size it may possibly attain. I have seen one as large as my hand in each groin of the same individual; they are easily distinguished from the venereal, when they assume a herpetic character, and heal in one part whilst spreading in another, which the latter never do. The mercurial ulceration often attacks the cicatrix of a recently healed chancre, and a fresh sore is thus formed

* Severalulcers with whitish-gray bases, bleeding easily, acid exuding thin matter

Serpiginous idlers in the skin (after working several years)

On the face, eruption consisting of a tetter about the mouth and on the cheeks, with hard and very superficial ulcers

Erysipelas and gangrene of the lips, with violent fever, thickly coated tongue; the gangrene extended and destroyed also a portion of the right cheek; there developed also on the right temple a gangrenous spot, which on opening discharged offensive gas and pus (the patient died after three weeks with hepatization of the upper portion of the left lung)

Ulcer on the foot

Small easily bleeding ulcers, of a dirty-white color, with livid borders, on the lips

Varicose ulcers on the extremities were frequent; indeed it was an exception to find a worker free from them

Sensations. Formication

Fuzzy feeling in the arms and hands

Sleep and Dreams p. 233

Sleep^ness. Sleepiness, for eight weeks

Sleepiness, with great anxiety

Great sleepiness, but sleep very much interrupted and disturbed by bad dreams

Drowsiness

Sleep, but half awake, with heavy dreams and fantasies

Sleeplessness, Sleep very imperfect; frequently awoke starting and frightened, and was troubled with incessant unpleasant dreams (one)

Sleep bad, with frightful dreams

Disturbed sleep

Sleep greatly disturbed

Restless sleep, with frightful dreams

Loss of sleep

Very little sleep, which is disturbed by dreams and nightmares (after thirty-eight years),™.

* Sleepfe.?ne-s.s,®® ®* ®', etc.; for months

Sleeplessness, with hallucinations, heavy dreams, nightmare

Sleeplessness; or the sleep was frequently interrupted by jerkings, and disturbed by heavy dreams

Sleeplessness; on falling asleep he fancied that some one called him, started up in fright and became chilly

Obstinate sleeplessness; nights disturbed by nightmare and half-waking dreams

Sleepless night

Night sleepless, especially after midnight

The patient had no rest at night, would stand up, wanted to walk about, saw ghosts, animals which were jumping at her, thought men were on the bed, thought living things were creeping into her mouth and vagina

Starting up in sleep

Dvecims, Heavy dreams

Frightful dreams at night

Fever p. 234

Chilliness. Skin cold and dry

Whole body cold

Constant chilliness, even in a heated room and in bed

Frequent chill and heat

* Those suffering from tremor frequently complained of a sensation of coldness, though without diminished temperature; one person wore a heavy overcoat, even in the hot summer

Heat. Increased temperature

Heat of the skin above the natural standard

Skin hot and dry

Feverish and very uneasy (after twelve days)

Fever

The common erethic fever, or fever of salivation, characterized by quick pulse, hot and dry skin, red gums, swollen tongue, salivation, loss of appetite, restlessness, headache, etc.; this may continue as long as the poisonous effects of Mercury continue in the system, for weeks and even months. Another kind of fever is the adynamic mercurial fever, characterized by depression of strength, precordial anxiety, frequent sighing, partial or universal trembling, a small quick pulse, a pinched and cadaverous countenance, a sense of coldness; the tongue is seldom furred ; a sudden and violent exertion may sometimes prove fatal

Hectic fever

Hectic fever and phthisis pulmonalis

(Intermittent fever seems very prevalent among the workers in nearly all the mines and factories, as reported by nearly all observers, but whether due to Mercury or local causes is uncertain.

One of the men who escaped the salivation suffered from quotidian ague

Sweat. *Sweats

* Profuse sweats at night

Constantly bathed in sweat, though in a state of collapse

Very copious perspiration

Profuse perspiration, at night

* Profuse offensive perspiration

Skin dry; easily desquamating

Conditions p. 234

Aggravation.

(Morning), On rising, headache ; aching in left arm ; tremors.

(Evening), Vertigo ; tremor.

(Night), Hallucinations, etc.; falling asleep of arms, etc.; heaviness in extremities, etc.; tearings in hands, etc.; oppression of breath ; sweats.

(In bed), Tearing in limbs.

(Beer), Headache, etc.

(Closing eyes). Tremors.

(Eating), Eructations; hiccough; vomiting; pressure in stomach.

(Emotional disturbance), All symptoms; tremor.

(Exertion), Jerking of hands.

(Change of weather), nervous feelings.

Amelioration p. 234

(Intoxication of wine). Tremor.

(Rest), Tremor.

■ (Ardent spirits), Loss of power in hands.

Footnotes

† These are the utmost care has been taken to a%mid any complication with disease; especially have the effects of Mercury in syphilitic cases been omitted.

† Dr BiUhtnann’s “emanation provings,” from holding a sealed vial of Mercury in the hand, Horn. Vierteljahrsschrift, 15, 301, are omitted.—T. F. A.

† An important point in the differential diagnosis between this and lead poison' ing, since in this latter the flexor muscles are the ones particularly affected.

† This was ineffectually treated with gray ointment until salivation occurred; the palms of the hands and soles of the feet were free from the eruption.