Page:Treatise on poisons in relation to medical jurisprudence, physiology, and the practice of physic (IA treatiseonpoison00chriuoft).pdf/330

 The last point to be noticed regarding mercurial salivation is the manner in which it proves fatal. Death may ensue from the mildest preparations, and from the smallest doses, in consequence of severe salivation being produced by them in peculiar habits. Two instances have been already mentioned which illustrate both of these statements, and others might easily be referred to were the fact not familiar.

Death may be owing to a variety of causes. Some of those which have been assigned are direct and unquestionable in their operation; others indirect and more doubtful.

The most direct and obvious manner is by extensive spreading gangrene of the throat, mouth, face, and neck. The late happy changes, introduced into the treatment of syphilis and other diseases which are benefited by mercury, render this mode of death rare in the present day. Yet I may mention that I have seen an example of it in a woman who was salivated to death, because her medical attendant, a firm believer in the powers of mercury as an antidote, forgot that the antidote is itself a poison, if not given in moderation. In general, when gangrene is the cause of death, it begins within the mouth or in the throat, and spreads from that till it even reaches the face. But sometimes it begins at once on the external surface, at a distance from the primary ulcers. An example of such a progress of the symptoms has been related by Dr. Grattan. A child ten years old was violently salivated by twenty grains of calomel given in six days. On the fifth day of the salivation, a little vesicle appeared on the skin near the mouth on each side, and was the commencement of a gangrenous ulcer, which spread over the whole cheek, and proved fatal eight days after its appearance.

Another cause of death appears to be exhaustion from profuse and protracted discharge of saliva, without material injury of the mouth or adjoining organs.

A third manner of death which I have witnessed is exhaustion from laryngeal phthisis; and from the circumstances of the case, I have little doubt but, in the state to which patients are then sometimes reduced, death may also take place suddenly from suffocation. My patient had undergone before I saw him five long salivations for a venereal complaint, and had latterly been attacked with symptoms of ulceration of the glottis. This affection went on slowly increasing, and he died of exhaustion after many weeks of suffering. During this period he was repeatedly attacked with alarming fits of suffocation, which were relieved by the hawking of mucous flakes. The symptoms were explained on dissection by the appearance of extensive ulceration and thickening of the glottis, and almost total destruction of the epiglottis.

The other causes of death are more indirect, and will be mentioned presently. They depend on the pre-existence of other diseases, on which mercury acts deleteriously during the state of erethysm excited by it in the constitution.

Of Mercurial Tremor.—The second division of the secondary