confined to healthy organs, they can never demonstrate tha ?erjn$ no action ... aCh a rapid return .... physiological action, we may affirm that children are as.
Article -The Action ARTICLE III.111.?The
Stephenson, M.D., F.R.C.S.E.,
pital
for Sick Children.
in in Children. Children. i>y V'lW Physician to the Roya
of Mercury
the iklvuicu{Read uvjurv before uiv Edinburgh, Medico-Chirurgical Society uj of Jhuutuuryiv^ is/ururyicuc nucitiy
\jlwujii
As the
^st
]\farch?)
^
eontii1^'^1^ ^jcl1
communication was promised as a -L a subject which has been under discussion in this Society, permitted a few prefatory remarks in reference to the bearing the discussion has so far had, and of that which this papel tended to illustrate. The subject was opened by an attack upon the generally P1 a opinion as to the action of mercury on the liver, based uponto of physiological experiments upon dogs, which were held that the supposed action of mercury did not exist, and that, tn it is useless in hepatic derangements, and should be en*U,6 carded. A gentleman who took part in the debate very pel endeavoured to show that such physiological experiments, value in and of being furtn the
following
foe
jir
_
themselves, worthy greatest a secuted, could not, and likely never would, supplant which in medicine. While the empiricism opinions upon
gerje3 vg
j^ore,
^
l^Q of ^^ atior1^
r
^at they ren gard to the action of mercury in cum This lias arisen ian if eve ^ ^ rarely susceptible to its constitutional action My and is based on the fact that young T
0 *
.
solely
salivated, opinion
readily more
arC
physiological
while all other cons is, that in children the and the adult, in than produced v effect, an
,
grai days from 1 and morning. Here, then, is a consti u twelve grains. It is a therapeutic action, the
decided
results in six
mor
in the
^ produces nQt sa\ivation
1
rapidly injurious guide-, but take another index one1 I0, i< In syphilitic eruptions in children, a
ignored, are
effects
as
readily observe
'
frequently
seen ve
nig powder loss th
Gffect from the f"\0ubt, and one but *ca\ effects, , under its influe
p iy_ fore which may be evinced before br g indicates that the constitution lias been A smaller amount, however, if otlierwis^ g perceptible influence on the economy-
.
wi\\
produce v
^rst of the mor
982
f}lAf
DE WILLIAM STErHENSON ON THE
" says Dr Clarke, is a state of pallor, with sickness, fretfulness, green mucous evacuations. appearances, especially those of the evacuations, are freque ^ ^ ferred to the infant's malady, real or supposed. They are, the usual, the natural, effect of the remedy." i Dr Lewis Smith remarks, " Calomel, when administere j0ye lias a very depressing effect;" and Dr West, referring to its ^ ment as a purgative and alterative, says, " There is no doubt ^ ' used with either of these objects, it is a remedy of great va ijsh the objection to its employment is, not that it fails to acc these ends, but that it answers them at a greater expense o tutional power than was necessary. Other renlC jepres3' that an alterative power over the secretions, without any of influence of mercurials." which attends the use ing ^st' My experience entirely corroborates the opinion of is 0 worthy observers ; and the period at which this result is dependent almost entirely upon the mode of its adminl ^ct The effect is produced in two Avays: first, by the irritan tlie upon the mucous surfaces of the alimentary canal impairing secondly? and results tion, producing sympathetic ; and, action of the drug on the economy in general. a c3re Much of this depressing influence may be avoided by j^ing dete administration ; and other effects must be looked for in ^3. its action. The most important of these is the production ot The most extreme case of this condition I have seen in in the case of a child a few months 0tfold, when, for some a doz the medical attendant had
effects of
calomel," and
_
coiis^'
.
.
.
.
^tai1^
rjfyeS0
prescribed
symptoms,
ders of a grain of gray powder in each, with some sugar** were all administered, but as the child was still ailing? an > repeated by the parents, without consulting the doctor,the c dozen had been got, but not administered, when I saw a have since then several times observed the same effect, ^ Jn ^ to be watch?. rtant anaemia as a most symptom regard important the administration of mercury :cury for the constitutional affecti?n children. 01n(J the If, then, we take the depressing influence of mercury production of anaemia, and not salivation, as our sUSceP as I J O action,7 we may affirm that children are physiological so. tible as adults to the action of mercury, if not more i0yifle. So much as to its baneful effects. I turn now to its emp leas in the intestinal derangements, and select one of the eated class of cases, viz., where an otherwise healthy child is somewhat from constipation, and is passing white, chalky 1 All are agreed that such a condition is produced by digestion and the absence of bile in the intestines. I s? such cases with mercury alone. The results have been c no change in the character of the motions, but considerab and pain. When further action occurs, the bowels are
^
watched
t],c
*eS!,c
J
#
i.
cQlI1pli'
^ ^.eated^^jeti11105
-pin#
983 ACTION OF
1871.] moved,
MERCURY INXHILDM
softer in character, and
^ al?
Mercurial motions
"V
appearance is entirely altered, r.CTUC Stopping tained, which continue tor some o T vea\t\vy evacuations the favourable cases, a return other rem thout some and se to motions aa' hut place, very gradually, the old chalky agency while, in the unfavourable, an
Z'ueS
?
?
?
^
theylike ^Whers 1 leave to explain Vv7 liether as
some
^
tardy
ro we the green evacuations. certainly > when or :i the be hile from given11 flowing ^ may sider the other explanations ot the res for the u necessity o successful cases, the frequent failures, ^ no evidence other remedies to establish the effce , the liver whi n special action in such cases on the r>hvsiological cxllCUm ?os o j _P in any result the in many c controvert way ^ t w^\\ obtained A dose of castor-oil and regulation of tbat tban suffice to bring about a much more with other from mercury alone. "When compar ^ more especia y j which have a supposed action on the i ^om satisfactory.1 l^arb and phosphate of soda, its action ^ and freeing eathartic action alone, by unloading culation, is quite sufficient to explaine p e(j_ to, but it is mxJ} f.tion Jaundice in children might also ^ that it is aT*.a, i sary to discuss it in detail. Hy expen action whic all y which yields to the simplest treatmen , n-rect character sam the of is eury has upon the liver of w i spoken of. +ivP treatment c as , There is another very important ^arr^ceaj with iei y goes against mercury: it is where t Cation of inflamma e e , white watery evacuations, without any irritant its iuce in the action. In these mercury is very apt top improVement wit i changing the colour to green, but tliat is Prl?ar* J ia\ live the not is it child's condition. In fact, ^ benehciaL of doses minute and even did gome 0ther organfault; s a effects, I should ascribe its effects to i or j tnind must be on The employment of mercury, there action ^ direct s in what cas upon other reasons and for other en and these what those w ^ ^ hiliary secretion. To determine 0 it should be have n we must look employed, experiments b We mentioned. Although it may not n yet explained how it operates^ that is aC used after the manner of a rational emp 0f a bili?uS in s ? In the obstinate and calomel have seen the vomiting arrested by a had reIiaedies thew laid on the tongue and swallowed, w len in treatment heing at once rejected. I first wltnesse extensive prac
gall-bladder
-
.
the^
.^medies
?
thebowe^
^
ernpv_
^
,
c
?a
c0P^
^
'
P>ysl?loSlCT,aSOnPwhy .
protracted re^c
4
I
^tfeBoyalInLnaTyimderl)r^bie,w^ w afforded him many opportunities of conmn
?-
tllis
benefi
9S4
1
DK WILLIAM STEPHENSON ON THE
f
an{^ that influence its action but in its depressing mouth, ration of +1? 11 blood. with the object so far, and 4. rp, used only the character not .be tissues, changes of the such it should be used a that as not c constituent f at intervals, W?0d'. and 1 occasionally, and
3. That
'
adults1 'f1 o*
stimulatir^ ^hS^0U^4 ^^tritive
^hipTspn tinuouslv
1
01
?^lat *s>
inflammatory
action is v
acute is no ques U^6 ^n. mo^fying but that there starting observation, ^*nited and^ in le^Ulres ^urther of inflammation, been arres as to its n ?Ver ^ie Pr?ducts where these have in '
5 Tint
^ tion and absorption, change to ^so^ 0t^6r rerne(^ies fail in producing the return
Process of r
and that
bid nutriti?n' action 0
a ? no
a
^ may
succeed
in
number of cases
promoting
improperly treated
hea
with mercur
988
[j!A*
THE ACTION OF MERCURY IN CHILDREN.
of
number of constitutions shattered by its abuse, no numbei ^ stances where disease has been cured without it, can in invalidate the results of its effects where it has cured when J ^ remedies liave failed, or lessen in any measure the position here defend of a judicious use of the medicine. ry in It remains for me only to refer to the method of using th6 the affections of syphilis in children. I shall not enter in .Qjl ?" question whether mercury may not be dispensed with ; my n j \ ^ is that its power over the diseased nutrition is second to never care to treat a case entirely without it. At the same would remark, that it is not the only remedy we have in sue1 ^ |t and it should never be used alone. It is to what extent sli be employed that I would refer. ^ iir Here my practice differs from many writers. What fluence by mercury is not the syphilitic diathesis, but pathological results. The former never can be eradicated; p diseased action occurs, that can be modified, and mercury ^ill u return to healthy action; but that attained, the continued jn are inne never eradicate the which tendencies pathological j^tic the character of the constitution. Mercury will cure the syp tn diseases of the first year of life; but no extent of its use at ^ will lessen the tendency in after years to interstitial keratitis? ^v6 ^ later manifestation of the taint. Its use therefore must be, as before said, the whip or the spur, while we follow up its ac ^ other and safer means. I do not therefore " continue its u every manifestation of syphilis has disappeared," as recomn by Diday,1 but stop it whenever improvement is manifestedc ^t6 symptoms, and change to iodide of iron, iodide of potass, andna ^ of potass. These are most valuable remedies, but alone ^ the same power as when combined with mercury. Under t ^ the symptoms may return, but the spur can again be app*ie ' ajnS in this way I have found that a fortnight's use of one or of gray powder daily is sufficient at any one time, and the period I consider it safe to continue it without interruption.
an^0tjier
nie!"C.0
none|.jII1e,
?e^heI1 .
aj"3
_
1
Diday
on
Syphilis,
p. 2G2.
r10V
