of spasm to other muscles, and believing tnat the nerves about the joint were no doubt primarily implicated, I proposed amputation, with the intention of removing the right arm at about its centre ; the patient, however, refused to submit to any Chloral in large doses was given, also operative measures. stimulants, and as much milk as the patient could be induced to take. Towards evening the spasms increased in frequency, but were, until the last and fatal one, never very violent; the pulse became weaker and quick, and the respiration frequent and shallow. At 5 r m., I directed one-third of a grain of hydrochlorate of morphia to be subcutaneously injected, but before this was done, he got two very severe paroxysms of minutes spasm, during the second of which he expired. Twenty after death, Casella's self-registering clinical thermometer indiand an hour after death, the cated 105'4 in the left

axilla, temperature noted in the same position

was

103?5.

morning I carefully dissected the seat of injury, paying particular attention to the various nerves in the vicinity of the elbow joint. The cellular tissue was ecchymosed at the inner and posterior parts, and some serous infiltration existed; the wound at the back communicated directly with the interior of the joint. The median nerve, just where it gives off its interosseal branch, w^s red and swollen, but did not seem The next

softened ; the ulnar nerve, where it lies between the olecranon process and internal condyle was quite red, and in close contact with the ligamentous structure and synovial membrane of the joint, which, on its inner aspect, was here of a brownish colour, and in a semi-gangrenous condition and very foetid.. The musculo-spiral was traced, but appeared normal, and none of the nerves seemed to have been directly injured either by the fractured bone, or by having been jammed. It is evident that the ulnar, in close proximity to the semi-gangrenous tissues of the joint, was more or less implicated, and no doubt propagated its state of inflammation or irritation to the spinal cord. &c. I believe early amputation in this case would have given the man a chance of recovery. Tetanus is peculiarly liable to occur as a consequence of compound fracture of the elbow and knee, and taking all cases of compound fracture, we have an average of 2 52 per cent, of cases thus terminating, as shown in Guy's hospital reports; whereas from the same record it appears that only 0 073 operarations, b.oth major and minor, have been followed by lock-

jaw.

CASES Treated

by Surgeon-Major F. Odeyaine, F.R.C.S., Bliopal Battalion. (Indian Series.) TRAUMATIC TETANUS.

The patient, aged 42, a strong muscular sepoy, in the Bhopal Battalion, fell from a tree on the 4th of the present month. On admission into hospital. I found a wound about two inches in length extending across the posterior aspect of the right elbow joint, with which, I had no doubt, it communicated, as there was synovial discharge. A comminuted fracture of the lower end of the humerus extending into the joint was diagnosed, the broken limb was put up with angular splints, and carbolized oil dressing in several layers applied to the wound. There was considerable discharge of synovia and pus from the joint and wound, which looked unhealthy, the tumefaction however subsided somewhat, and the patient appeared to be progressing as favorably as could be expected. On the morning of the 10th, or six days after receipt of the injury, it was first

noticed that there was a certain amount of trismus, and very soon the patient could scarcely open his mouth; a gag of soft wood was placed between his teeth, and he was given 20 grains of chloral, which was^ continued in smaller doses, so that he had 75 grains taken in the 24 hours ; a tobacco poultice was applied to the 'wound, and he was constantly plied with milk when awake. He slept off and on between the doses of chloral, and took his milk fairly well; muscular extended rigidity gradually to the back of the neck, mastoids, and the pectorals slightly, respiration being easy, and the pulse pretty good. On the morning of the 11th, seeing that there was no doubt as to the extension

The chloral in the above case certainly mitigated the violence of the proxysms, but had little influence on the progress of the disease, which was rapid, namely, 35J hours from the first symptoms till death. The high temperature noted immediately after death, and 103 J ? an hour afterwards, is what we may expect in a disease in which the thermometer has touched 113CF. an hour after death, as quoted by "Wunderlich from his own observations.

Sehore,

C.

I.,

24tli

April 1877. (To be continued.)

Cases (Tetanus).

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