CALABAR BEAN IN TETANUS.

By In

endeavouring

to

C. Macnamaka.

appreciate

the value of calabar bean desirable, in the first into two classes first, those in which

administered in cases of tetanus, it

place,

seems

to divide our cases the muscles supplied by nerves cord are involved; and

proceeding from the spinal secondly, instances in which the muscles receiving their nerves from the medulla oblongata are implicated ; in the majority of cases of tetanus the medulla and cord are both compromised, but these hardly seem to me to illustrate the influence which, I am inclined to think, calabar bean exercises

following

over

the first class of cases, and

of which the

disease, kindly reported for me by Mr. Hinder, is an example. In this case it is evident that the muscles supplied by the eighth and ninth pairs of nerves were hardly involved in the tetanic spasms, and we may reasonably, therefore, suppose the nerve elements of the medulla oblongata were comparatively unaffected ; whereas the muscles supplied by nerves proceeding from the spinal cord were constantly thrown into the most violent spasms. This patient, although discharged from hospital cured of his tetanus, had by no means, when he left the establishment, recovered from the stiffness of the limbs which, according to my experience, generally follows a severe attack of tetanus, aud which can hardly be instance of the

Juxe 1, 1871.]

CASES TEEATED BY INJECTION OF

QUININE.?BY

P. CT7LLEN".

jo7

with Liebig's extract of meat, beat up in milt--a small quantity tlie result of the violent contractions to which the affected given every four hours. being muscles had been swbjcted during the tetanic spasms. This The largest quantity of the extract of the calabar bean stiffness of the muscles after tetanus seems to me rather taken in one day was sixty grains. One ounce fire drachms to iudicate the existence of reparative changes going on in the and fifty-three grains of the extract of calabar bean, and nervous matter of the spinal cord and medulla, for I hareone ounce and fire drachms of the chloral hydrate, were taken always found small hemorrhagic effusions in these localities this patient in 20 days. after death from tetanus, but beyond lesions of this descrip-by The effects of this extract of calabar bean were tried tion I have never satisfied myself as to the presence of degenon other patients, and it was found to bo perfectly good ; its erative changes in the proper structures of the nervous cen-characteristic symptoms being developed on the iris when tres. Doubtless as the small blood clots formed among the to the a dilute solution was

elements of the nervous centres during the attack of tetanus being absorbed, and the spaces they had occupied were being filled up by healthy elements, the nerves connected with the spots undergoing reparative changes would participate in the hyperaction, and this, influencing the muscles they supply, would perhaps account for the stiffness of the limbs, from which patients suffer for a month or two after a severe attack were

?f tetanus.

Baghuth, aged 35, a slender but muscular Ooriah eoolie, was admitted into the Chandnie hospital on the 19th of February,

1871, with a contused wound over the back of the left hand. slough formed at the site of injury which gradually became detached, and was cast off on the 5tli March, leaving a clean healthy A

sore

which

was

dressed with lint soaked in carbolic oil. On the after the receipt of injury,)

following day?6tli (sixteen days,

the patient's features became pinched, and the characteristic expression of approaching tetanus became unmistakably developed. On being questioned the patient complained of slight stiffness in the muscles of the neck and chest, but of no trismus or difficulty of deglutition. Dr. C. Macnamara ordered calabar bean to be given; at first one grain of the extract (procured from Messrs. Scott, Thomson & Co., originally from Marson & Co., London,) was ordered every 2nd hour, its effects to be carefully watched : in addition tho patient was ordered two scruples of chloral hydrate at bed-time. On the morning of the 7th it was recorded that the patient had slept after taking the chloral, temperature in axilla 98, pulse 84, respiration 18, pupils contracted : to have one grain of extract calabar bean every 2nd hour, during the day, and two scruples of chloral hydrate at 10 p.m. In the evening the temperature of the body was 99, pulse 86, respiration 18. On the 10th March opisthotonic tetanus was well developed, but no trismus ; deglutition unimpeded; temperature 962, pulse 84, respiration 24 ; pupils very much contracted; ordered one grain of extract calabar bean every hour, and the chloral hydrate to be continued every night. The spasms now became very intense, so that the dose of the extract of calabar bean was increased to two grains every hour. On the 14th the spasms were still severe, and very easily excited, no trismus or difficulty of deglutition, temperature 99, pulse 10S, respiration 30 ; patient looks worn and exhausted ; to take three grains of extract of calabar bean every hour during the day. At 8 p. m. spasms were much less severe and of shorter duration; the patient has taken during the day no less than forty-eight grains of the extract of calabar bean; he has not slept; temperature 99'3, pulse 126, respiration 42; to have two scruples chloral hydrate at 10 p. m. This treatment was continued, as the patient progressed favourably, and on the 17th the spasms were reported as being much less severe, though still readily excited ; skin bathed in a profuse cold sweat, pupils contracted, has had sixteen liquid stools within the last 24 hours ; always sleeps well after the chloral hydrate. The diarrhoea having ceased without interference, the above treatment was continued (though the spasmodic contractions were merely nominal after the 20th?fourteen days from the commencement of attack,) until the 26th March. He was discharged from hospital on the 12th April. The patient's diet consisted from first to last of raw eggs,

very

applied conjunctiva. (To be continued.)

Calabar Bean in Tetanus.

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