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Synonyms.—Ptyalism; Chronic Mercurial Poisoning.

Definition.—A chronic mercurial poisoning, caused, either by ingestion of the drug, or by inhalation or absorption of the mineral in the industrial pursuits.

Etiology.—Ptyalism from calomel has become quite rare in recent years, since this much abused drug has found its legitimate use in medicine; however, to one peculiarly susceptible to the drug, small doses may give rise to mercurial poisoning.

The most common cause is the inhalation of the vapor of the mineral by workmen engaged where this mineral is used; thus workers in quicksilver-mines, especially those in smelters, also mirror-gilders, makers of thermometers and barometers, and all who use the salts of mercury in the various trades.

Pathology.—No marked changes are found in either the central or peripheral nervous system. Acute inflammation of the mouth, stomach, and bowels are the most constant lesions found. Irritation, and frequently inflammation of the kidney, is also noted in some cases, while degeneration of the liver is not an uncommon sequence.

Symptoms.—The early symptoms are swelling- of the gums, which become tender, soft, and spongy, to be followed by ulceration. The breath is offensive, and a metallic taste is usually present. Ptyalism is a characteristic symptom. The teeth become loosened, and sometimes fall out. Necrosis of the jaws may occur in severe cases.

Diarrhea, with abdominal pains, is usually present. The urine becomes scanty, high-colored, and contains albumin and casts.

Tremors are characteristic, and are generally first noticed in the tongue and lips, but gradually affect the entire voluntary muscular system.

Paralysis of the various muscles may occur, though they do not atrophy. Arthritic pains are experienced, and the patient gradually becomes anemic and emaciated.

Diagnosis.—Given the history of exposure to the metal, or ingestion of the drug, together with the stomatitis, ptyalism, ulceration, tremors, paresis, etc., and the diagnosis is easily made.

Prognosis.—The prognosis is generally favorable.

Treatment.—If due to the use of mercury, the drug must, of course, be withheld; and if due to exposure in any of the industrial pursuits, the patient must be removed from the offending cause. As a wash for the stomatitis, potassium chlorate and hydrastine phosphate are almost a specific. The same agents are also of much benefit given internally.

Phytolacca 20-30 drops.
Water 4 ounces. M.

Sig. Teaspoonful every two hours will give good results.

To aid in the elimination of the mineral, potassium iodid may be used, and sulphur-baths practiced. Galvanism is also useful in eliminating the drug.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.

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