% J$tiililoi[ of io.'ipilal Iniqfiiic. acute tetanus treated
by intraOF INJECTION TETANUS cerebral ANTITOXIN. By W. H.
QUIOKB, F.It.C.S.,
MAJOR, I.M.S., Second
Surgeon,
Sir J. J.
Hospital, Bombay.
The following three cases of acute tetanus treated by the intracerebral injection of tetanus antitoxin may be of interest, as this method of treatment is now on its trial. H. K., age 26, was admitted on 2nd November 1898. The patient states that about seven days ago he received a contused wound on the right leg from the wheel of a cart.
Nov.
1899.]
OASES FROM HOSPITAL PRACTICE.
407
Remarks by W. K. Hatch, F.it. c.s., Lieut.-Col., There is a wound of about the size of a twoI.M.S.?The notes of the above cases were made for me by Major Quicke, who operated on anna piece situated oil the external malleolus of the right leg. them at my request, with the object of testing The patient is suffering from tetanic spasmsthe efficacy of this method of treatment of which occur frequently. Pulse 120 ; respirationtetanus. The serum was supplied to me by Professor Wright while in Bombay, and I under30; temperature 103'2? F. The patient was put under chloroform, astand he procured it from Dr. Roux. On one small flap of scalp was turned down, and a smalloccasion Professor Wright was present at the inhole drilled in the skull by means of a dentaljection, and in fact the operation was performed engine over the posterior end of the middleunder his direction and by his special request. frontal convolution. 5 c.c. of antitoxin serum The first two cases were extremely severe ones, were injected into the brain. The fluid was in-and would have proved fatal in my opinion, jected very slowly, occupying a period of 20under any method of treatment; the third case minutes. The flap of scalp was replaced, and thewas a fair one to test the antitoxin treatment. wound dressed antiseptically. The wound on It seemed to me that the severity of the the ankle was scraped and dressed. symptom was in all cases increased by the 30tli November.?The spasms continued toinjection. The duration of the operation in increase in frequency during the night. Pulseeach instance was 20 minutes, the fluid 120; respiration 44 ; temperature 103*6? F. The being injected very slowly, and I may mention that the perforation of the cranial bones was patient died in the afternoon. A post-mortem examination could not beeffected by the dental engine. It was observed in two of the cases that a small cavity was obtained. B. N., age 26, admitted into the J. J. Hos- present in the brain at the site of injection, pital on the morning of 1st December 1898, and that this cavity contained a small quantity suffering from acute tetanus of three days'dura- of the fluid. As the post-mortem examination tion, states that lie received a small lacerated was made 20 hours after death, it seems wound on the forehead two days ago. No history that absorption of the injected fluid is not very of any other wound. rapid. I should hesitate to use this method of treatThe spasms are very frequent. Pulse 104; respiration 28; temperature 102 8? F. 5 c.c. of ment on another occasion except, perhaps, in the tetanus antitoxin were injected into the motor very earliest stage. area of the right side of the brain. Time occupied injecting the fluid was about 20 minutes. The spasms became more frequent during the day, and the patient died at 2-30 p.m. Post-mortem examination 19 hours after death. On cutting into the ascending parietal convolution a small cavity, about the size of a bean, was found. This cavity contained some of the antitoxin serum. Round the walls of the cavity some small hemorrhages had taken place. G. S., age 20, admitted into the J. J. Hospital on the evening of the 6th December 1898 with acute tetanus of two days' duration. The patient states that five days ago he received a small lacerated wound on the left knee and left elbow while playing with one of his friends. The spasms occur about every half hour. Pulse 88; respiration 28; temperature 99 4?F. 5 c.c. of tetanus antitoxin serum were injected into the middle frontal convolution of the right side. Time occupied in injecting the fluid was about 20 minutes. The wounds on the knee and elbow were excised. 5 c.c. of serum were also injected into the left buttock. 7th December.?The spasms have occurred very frequently since the operation. Pulse 72; respiration 32; temperature 101'2? F. Rth December.?Spasms more frequent. Pulse 104 ; respiration 36 ; temperature 102? F. Patient died in the afternoon.
by intraOF INJECTION TETANUS cerebral ANTITOXIN. By W. H.
QUIOKB, F.It.C.S.,
MAJOR, I.M.S., Second
Surgeon,
Sir J. J.
Hospital, Bombay.
The following three cases of acute tetanus treated by the intracerebral injection of tetanus antitoxin may be of interest, as this method of treatment is now on its trial. H. K., age 26, was admitted on 2nd November 1898. The patient states that about seven days ago he received a contused wound on the right leg from the wheel of a cart.
Nov.
1899.]
OASES FROM HOSPITAL PRACTICE.
407
Remarks by W. K. Hatch, F.it. c.s., Lieut.-Col., There is a wound of about the size of a twoI.M.S.?The notes of the above cases were made for me by Major Quicke, who operated on anna piece situated oil the external malleolus of the right leg. them at my request, with the object of testing The patient is suffering from tetanic spasmsthe efficacy of this method of treatment of which occur frequently. Pulse 120 ; respirationtetanus. The serum was supplied to me by Professor Wright while in Bombay, and I under30; temperature 103'2? F. The patient was put under chloroform, astand he procured it from Dr. Roux. On one small flap of scalp was turned down, and a smalloccasion Professor Wright was present at the inhole drilled in the skull by means of a dentaljection, and in fact the operation was performed engine over the posterior end of the middleunder his direction and by his special request. frontal convolution. 5 c.c. of antitoxin serum The first two cases were extremely severe ones, were injected into the brain. The fluid was in-and would have proved fatal in my opinion, jected very slowly, occupying a period of 20under any method of treatment; the third case minutes. The flap of scalp was replaced, and thewas a fair one to test the antitoxin treatment. wound dressed antiseptically. The wound on It seemed to me that the severity of the the ankle was scraped and dressed. symptom was in all cases increased by the 30tli November.?The spasms continued toinjection. The duration of the operation in increase in frequency during the night. Pulseeach instance was 20 minutes, the fluid 120; respiration 44 ; temperature 103*6? F. The being injected very slowly, and I may mention that the perforation of the cranial bones was patient died in the afternoon. A post-mortem examination could not beeffected by the dental engine. It was observed in two of the cases that a small cavity was obtained. B. N., age 26, admitted into the J. J. Hos- present in the brain at the site of injection, pital on the morning of 1st December 1898, and that this cavity contained a small quantity suffering from acute tetanus of three days'dura- of the fluid. As the post-mortem examination tion, states that lie received a small lacerated was made 20 hours after death, it seems wound on the forehead two days ago. No history that absorption of the injected fluid is not very of any other wound. rapid. I should hesitate to use this method of treatThe spasms are very frequent. Pulse 104; respiration 28; temperature 102 8? F. 5 c.c. of ment on another occasion except, perhaps, in the tetanus antitoxin were injected into the motor very earliest stage. area of the right side of the brain. Time occupied injecting the fluid was about 20 minutes. The spasms became more frequent during the day, and the patient died at 2-30 p.m. Post-mortem examination 19 hours after death. On cutting into the ascending parietal convolution a small cavity, about the size of a bean, was found. This cavity contained some of the antitoxin serum. Round the walls of the cavity some small hemorrhages had taken place. G. S., age 20, admitted into the J. J. Hospital on the evening of the 6th December 1898 with acute tetanus of two days' duration. The patient states that five days ago he received a small lacerated wound on the left knee and left elbow while playing with one of his friends. The spasms occur about every half hour. Pulse 88; respiration 28; temperature 99 4?F. 5 c.c. of tetanus antitoxin serum were injected into the middle frontal convolution of the right side. Time occupied in injecting the fluid was about 20 minutes. The wounds on the knee and elbow were excised. 5 c.c. of serum were also injected into the left buttock. 7th December.?The spasms have occurred very frequently since the operation. Pulse 72; respiration 32; temperature 101'2? F. Rth December.?Spasms more frequent. Pulse 104 ; respiration 36 ; temperature 102? F. Patient died in the afternoon.
