We describe four cases of mercury vapor inhalation with subsequent respiratory failure and death; these patients had attempted to extract silver from a mercury-containing amalgam. A 41-year-old man illegally obtained a silver amalgam preparation containing 50 percent mercury. He apparently stole the amalgam and heated the powder in a small smelter in an attempt to obtain pure silver metal. This process took place in the home of his father-in-law. Present during this event were his wife, her father, and grandmother. There were also two dogs within the home who subsequently died. All four patients denied this history when they first presented to local hospitals. All stated that they had been exposed to freon fumes while attempting to clean a refrigerator. The mercury vapor inhalation history was eventually obtained five days later when local public health officials, notified of the unexplained inhalation exposure, detected amalgam powder and the smelter in the basement of the home.
A 41-year-old white man was transferred to Henry Ford Hospital, Detroit, for evaluation of progressive dyspnea and pulmonary insufficiency. He had presented to a local hospital four days earlier because of nausea, shortness of breath, and nonspecific chest pain. On original presentation, he was mildly febrile, but results of his physical examination were otherwise unremarkable.