Introduction - Uppsala Monitoring Centre

disease, acrodynia, is caused by chronic mercury poisoning. The children
concerned had had calomel previously in the form of a dental powder or as
an ointment, or by mouth. The condition had been recognized in Australia in
1890 (Akabane, 1983) and in 1903 Selter reported eight cases of the
syndrome among children between one and three years of age (Selter,
1903). Selter used the term ‘trophodermatoneurose’, and his cases exhibited
the characteristic picture of the syndrome. The neurologic aspects of
acrodynia were emphasized by Swift in Australia in 1914 (Swift, 1914) and
by Feer in Switzerland in 1923 (Feer, 1923). The condition was established
as a clinical entity in the British and American literature by Byfield and
Bilderback in 1920 (Bilderback, 1920).
Withdrawn: during the time of Plato the physicians of Greece were prohibited
under penalty of death, from prescribing mercury and other drugs of a
poisonous nature (Abramowitz, 1934). In 1495 mercury was introduced for
syphilis.
Withdrawn worldwide in 1953, initially voluntarily by the manufacturers,
because of Pink disease (acrodynia).
Availability: still available in the USA. Calomel is still available in Hungary in the
form of a wound powder (Martindale).
Drug Lifespan: more than 458 years, but as mercury 3,453 years.
Delay in recognition: 2, 269 years, but if taken from appearance of syphilis then
427 years.
Delay in regulatory action: (time between first mention of the ADR and the first
withdrawal): 31 years.
Comment: the severe side effects of mercury were tolerated when there was no
other apparent effective treatments for syphilis, but the advent of Salvarsan in
1907 made it obsolete. Its continued use as an antiseptic was not warranted
since it was absorbed through the skin and there were better alternatives. Its
contemporary use in vaccines is dealt with under Thiomersal. It has been
suggested that there are other factors which interact with mercury to produce
acrodynia, e.g. avitaminosis. ‘If one does not admit, in effect, a favourable
background, nothing would allow the explanation that so many children taking
in one form or another mercurial medication and at doses extremely varied
following the indication, without ever presenting the picture of acrodynia’
(Launay et al., 1949).
The delay seems to be in the identification of a syndrome rather than in the
individual signs and symptoms, which had been known for a long time.
78 AD Antimony
It is said to have been known to the Chaldeans in 4000 BC, and that its sulphide
had been found in an Egyptian cosmetic case of 2,500 BC as a rouge to be brushed