Introduction - Uppsala Monitoring Centre

several symptoms. Renal damage and liver damage referring to biochemical
evidence and, therefore, not available at that time; but why no mention of
conjunctivitis? The word conjunctivitis was used in the 17 th century and its presence
would have been obvious, but it might only be caused by elemental mercury.
Perhaps compared with the other side-effects minor inconveniencies were not
deemed important. One of mercury’s effects, e.g. diarrhoea has an unexpected
beneficial effect in that it clears the bowel of any retained mercury and thereby
prevents further absorption and its inherent toxicity. The increased urine first noted
in 1737 was re-discovered in 1919 by Alfred Vogl with Novasurol and henceforth
was used as a diuretic (Vogl, 1950). In 1924 Mersalyl was discovered and became
the main drug used to produce diuresis.
Quicksilver is barely absorbed during its passage through the gut with the result
that it collects just above the anal sphincter and if the tone of the sphincter is relaxed
for a moment a spray of glistening globules is seen on the floor. ‘During a dance at a
public assembly a lady was thought to have dropped her pearls, but when her escort
went to pick them up he found, much to the lady’s confusion, that they were
globules of mercury.’ (Abraham, 1948).
The monstrous adverse drug reactions of mercury must be balanced by its
efficacy. Although the treating physicians and surgeons believed that it cured
syphilis they may have been mistaken, since there was a spontaneous resolution of
both primary and secondary syphilis. The course of untreated syphilis had been
investigated in a study in Oslo (1891–1951) which had 1,978 patients and, more
recently, in the unethical Tuskegee study in American male negroes 175 (1932–1972).
The primary chancre resolved in 2–6 weeks and the secondary stage developed
about 6 weeks after the healing of the primary lesion and consisted of a generalised
rash, headaches, fever, malaise, joint and muscle aches and more rarely alopecia,
laryngitis, hepatitis, nephrotic syndrome, bone pain and uveitis. All these resolved
spontaneously. During the period prior to the tertiary phase the syphilis was latent
and in about 60% it remained latent for the remainder of the patient’s life. The
tertiary lesions included: cutaneous gummas, mucosal gummas, bone syphilis,
visceral syphilis (liver, eyes, stomach, lungs, testis, haemolytic anaemia) and
neurosyphilis (Wright & Csonka, 1996). The doctors may well have mistaken the
spontaneous resolution of the primary and secondary phases, and the latency of the
third phase as being due to mercury treatment. Since the disease remained latent
how can one tell when a cure occurs? This differentiation only became possible
when a laboratory test, the Wasserman reaction, was discovered in 1906. The tests
have increased in their sophistication since then. It was in 1905 that the discovery of
175 Tuskegee Study. 399 poor male negroes and 201 healthy controls were followed up for 40 years. 28 died
from syphilis,100 died from conditions related to their syphilis, 28 wives were infected and 19 children had
congenital syphilis.