March 1,

\/

1877.]

'

CHOLERA EPIDEMIC OF 1875.

CASE OF IDIOPATHIC TETAJNTTS TREATED BY CHLORAL

By

Subhax

:

RECOVERY.

Ali, Assistant-Surgeon,

Hissar.

Bitdhoo Sais was admitted into the Government dispensary at Hissar, on the 10th October 1876, suffering from idiopathic tetanus. It appears that he lived in the Police lines, which are distant about a mile and half from the city, and that recently he suffered from an attack of fever, from which he has On the 9th October now recovered, but which prostrated him. he was carrying on his head a load of gram for his horse, and while conveying it from the city to the lines, he felt a choking sensation in his throat, and a difficulty in swallowing his saliva. After arrival at his home he cooked his food, but on attempting to eat it he discovered that he could not open his jaws. He was obliged to leave his meal untasted, and lay down. Spasms of the muscles of the body, attended with great pain, then came on. During the night he was taken to the Police hospital, which was near at hand, and there the hospital-assistant applied a blister to the back of his neck. No benefit resulted, and at 10 o'clock on the morning of the 10th I admitted him into the dispensary. lie then presented the following symptoms :?The risus sardonicus was well marked; the muscles of mastication and deglutition were in a state of tonic spasm, and he could not swallow anything. The respiration was difficult and irregular, his skin was hot, the forearm was strongly flexed on the arm, and the body was bent forwards in the form of a bow (opisthotonos), the back of the head and sacrum only resting on the bed. During the fits, which were brought on by merely touching his body and were very painful, he was unable to speak, but on relaxation of the muscles he could detail his history. He had not been able to empty his bladder since the commencement of the attack. Treatment.?The urine was drawn off by a catheter, an of castor oil and turpentine was administered, and a solution containing 10 grains of the hydrate of chloral was hypodermically injected in the left arm. In about ten After minutes the rigidity relaxed and the spasms decreased. an interval of half an hour the hypodermic injection was repeated. This was followed by some benefit, and there was a free evacuation of very offensive matter from the bowels. After another short interval, 40 grains of chloral were administered by the mouth, as he was now able to swallow although with difficulty. In fifteen minutes after this dose he fell asleep and remained so for six hours. When he awoke he was much better, the urine was again withdrawn by a catheter, the enema was repeated, and the following mixture enema

was

prescribed:? Morphia; Muriatis Chloral Hydrate Tinct. Hyoscyami.

Mucil. Gummi Acacise

M.

One ounce to be

given

...

...

...

...

...

...

...

...

gr i. grs. cxx.

ji. ?vi.

every 3rd hour.

After two doses the urine passed voluntarily, and the bowels of half an hour. The were twice moved with an interval muscles were perfectly relaxed and the spasms were diminishing. He again fell asleep and did not awake for two hours. He then got a third dose, but the spasms did not return. He slept again, and next morning, cxcept for a sensation of aching all over the body, the result of the previous violent spasms, he was perfectly well. The dose of the medicine was then ordered to be given three times during the day, and he was discharged cured on "15th October.

Remarks.?The foregoing

case is an example of a severe form idiopathic tetanus The man had been in bad health, there was an impoverished state of the blood, he was exposed to the heat cc the sun, and was fatigued by carrying the heavy load ead. Congestion and on his probably irritation in some part

of

of the

centres were Bet up and tetanus showed itself. the state of the atmosphere has something to say to the causation of this affection, for during the last half of and first half of October, I was aware that several September The weather was cases had occurred. stormy and unsettled ; electric there were several discharges during these days, and were cold while the days were hot. The value of the nights prompt treatment and constant watching are well exemplified by the above case, which, I hope, may be of sufficient interest to warrant its publication. icrvous

Apparently

71

Case of Idiopathic Tetanus Treated by Chloral: Recovery.

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