1832 The Lancet  
SIR,—There is a very interesting case I of gangrene of the mouth, produced by the violent action of mercury, related in the last Number of THE LANCET. This is an accident which will sometimes arise, even when the medicine has not been exhibited in excessive doses. In some persons a small quantity of this metal will produce almost immediate and most violent effects, but we are not in possession of a knowledge of the peculiarity of constitution upon which this susceptibility to its action
more » ... Your correspondent states that there is scarcely a case of gangrene in children, arising from this cause, to be found on record. At page 295 of my Compendium of Medical Prac-I tice, he will find a case, and the cause adverted to in the following terms :-' I have one remarks to add with respect to the use of mercury. Children will take an immense quantity of it, without the salivary glands becoming affected ; we ought not, however, on this account to give it mcautiously, for it will sometimes happen that without salivation the parotid duct will be excited by it into violent inflammatory action, in which the parotid gland and the whole cheek will be speedily involved, and sphacelus, or a rapid ulceration, will be the consequence. I have seen both cheeks entirely removed by this process. Nothing with which I am acquainted has the slightest tendency to check its progress." In this case very minute doses of hydr. c. creta (not more than a grain) in combination with bark, had been prescribed and taken twice a day for three weeks, when the child complained of soreness of the gums, and ulceration upon the inside of the cheeks. The medicine was immediately laid aside, but, on the following day, the ulceration had spread over the whole of the membrane lining the inside of the cheeks, and two small livid spots were to be distinguished externally tiirectlv over the terminations of the parotid ducts. These spots rapidly extended, and in seven days the whole of the integuments, and muscles of both the upper and under jaw, sloughed away, presenting the most ghastly aud pitiable object I ever beheld. The patient was nine years of age. the present day,) practised towards their junior brethren, by some who are, or imagine themselves, at the head of the profession' I refer, Sir, to what has occurred in the appointments that have recently taken place for assistants to one of the Cholera lios. pitals in Dublin. Immediately on the appearance of the disease in this city, a very extensive hospital was prepared, and it being necessary that medical men should be appointed who might be constantly on the spot, the surgeons of Stephen's and the Richmond hospital, having, by what right it is not easy to say, the disposal of thee situations, immediately appointed a number of their own apprentices. The consequence is, that young men, some of them mere boys, not more than two or three years at the profession, are intrusted with the care and treatment of cholera patients, whilst others may be seen driving about the city and its suburbs to determine whether cases are cholera or not. Now, Sir, what 1 would complain of is, that whilst there are many licentiates, and even members of the college, who would have been glad to have held the s i t u a t i o n s , professional men are to be found who should so far forget the interests of the college, and of the profession at large, as, through selfish and interested motives, to place their own apprentices over the heads of regular and qualified surgeons. It nMv be said that those persons were appointed because others more eligible did not come forward ; the fact is, that those situations, though refused by some of the pupils, wore not offered to the licentiates of the col'es'f, nor was it known that there wu'eto he such, until after the appointment had taken place, though I must here add, that there are one or two of these situations held bv gentlemen who are in every way qualified to un. dertake them. I should he glad to ask those gentlemen who have acted in thu manner, what is the use of haying a degree from a college, where we see the very per. sons who are appointed to give that degree, declaring to the public by their acts the worthlessness of their diploma, and that whenever situations are to be held which require the practical surgeon, or to which emoluments may be attached, their own apprentices are in every way as capable and as well qualified to hold them, aa the possessors of diplomas, which have cost tbem so much labour and expense to obtain, ind
doi:10.1016/s0140-6736(02)80306-3 fatcat:o5bs7ehpa5etpa5cvs2nz7t7fu