TWO CASES OF
TETANUS.
By F. P.
Nichols, b.a., m.b., Cantab. Surgeon-Major, a.h.s.
The
following
your readers:?
Chaudry M.,
cases
cat. 30, a spare, into the
man, was admitted lowers' Hospital at
1894 with very
may prove of interest to
healthy-looking
Regimental Fo?
Trimulgherry on 24th, March
well-marked
'
tetanus.'
300
INDIAN MEDICAL GAZETTE.
A fortnight previous to admission he had been treated as an out-patient for a wound in the sole of the right foot caused by a thorn. No thorn was found and the wound healed completely. On March 20th he said he had 'fever' and two days later stiffness of the jaws, difficulty in swallowing, and gradually increasing contractions in the muscles of the right foot and leg. On admission his jaws were tightly clenched, there was marked spasm|in both legs, increased on any exertion or pressure, and a tendency to opisthotonos. The old wound was well opened and washed out with strong carbolic acid. No foreign body could be found. He was allowed to be fed with milk and beef tea, and half drachm doses of Pot. Brora, to be giveu every four hours. Next da}'' he was worse, the spasms being more I decided to severe and more readily induced. put him thoroughly under the influence of chloral hydrate and ordered it to be given hourly in gr. xx doses with an equal quantity After of Pot. Brom. until he became drowsy. this he was to be kept in a half somnolent condition by the same drug, the dosing to be guided entirely by its effects. It was found that 80 grains in the 24 hours with equal quantities of Pot. Brora, sufficed to do this. Stimulants were also given in the form of rum. Under this treatment, which was continued for 14 days, the spasms grew gradually less, but he lost much flesh, his tongue became very foul, and he was delirious at night. On April 8th the chloral was given only at night in gr. xxx doses, but the effect was not good, spasm reappearing next day, and the old more frequent doses were renewed. From this date to May 8th he steadily improved, the doses of chloral and bromide being gradually reduced in amount. May 15th?he could walk fairly well, but was much emaciated. On pressing the wound which was not quite healed, a small thorn came out. Medicine was stopped. He was discharged well on May 25th. As if to discount any satisfaction I might feel over this case, on April 8th a woman was admitted into the Cantonment Hospital, Trimulgherry, under my charge, with clenched teeth, frequent spasms, and the usual symptoms of tetanus. She stoutly denied any possible wound or thorn, but after very careful examination my Hospital Assistant found a small piece of wood in a suppurating cavity under the nail of one great toe. This was excised and the wound thoroughly cauterized. She was put on the same treatment, chloral and bromide every hour till drowsy, and to be continued according to its effects. She improved a little for two days, the spasms being reduced from half-hourly to two-hourly, but died on April 11th in a severe paroxysm. 1 have to thank 2nd class Hospital Assistant Ramanjulu and 1st class Hospital Assistant Kuppusawmy Pillay for these notes and the care and attention they bestowed on the patients.
[Aug.
1894.
TETANUS.
By F. P.
Nichols, b.a., m.b., Cantab. Surgeon-Major, a.h.s.
The
following
your readers:?
Chaudry M.,
cases
cat. 30, a spare, into the
man, was admitted lowers' Hospital at
1894 with very
may prove of interest to
healthy-looking
Regimental Fo?
Trimulgherry on 24th, March
well-marked
'
tetanus.'
300
INDIAN MEDICAL GAZETTE.
A fortnight previous to admission he had been treated as an out-patient for a wound in the sole of the right foot caused by a thorn. No thorn was found and the wound healed completely. On March 20th he said he had 'fever' and two days later stiffness of the jaws, difficulty in swallowing, and gradually increasing contractions in the muscles of the right foot and leg. On admission his jaws were tightly clenched, there was marked spasm|in both legs, increased on any exertion or pressure, and a tendency to opisthotonos. The old wound was well opened and washed out with strong carbolic acid. No foreign body could be found. He was allowed to be fed with milk and beef tea, and half drachm doses of Pot. Brora, to be giveu every four hours. Next da}'' he was worse, the spasms being more I decided to severe and more readily induced. put him thoroughly under the influence of chloral hydrate and ordered it to be given hourly in gr. xx doses with an equal quantity After of Pot. Brom. until he became drowsy. this he was to be kept in a half somnolent condition by the same drug, the dosing to be guided entirely by its effects. It was found that 80 grains in the 24 hours with equal quantities of Pot. Brora, sufficed to do this. Stimulants were also given in the form of rum. Under this treatment, which was continued for 14 days, the spasms grew gradually less, but he lost much flesh, his tongue became very foul, and he was delirious at night. On April 8th the chloral was given only at night in gr. xxx doses, but the effect was not good, spasm reappearing next day, and the old more frequent doses were renewed. From this date to May 8th he steadily improved, the doses of chloral and bromide being gradually reduced in amount. May 15th?he could walk fairly well, but was much emaciated. On pressing the wound which was not quite healed, a small thorn came out. Medicine was stopped. He was discharged well on May 25th. As if to discount any satisfaction I might feel over this case, on April 8th a woman was admitted into the Cantonment Hospital, Trimulgherry, under my charge, with clenched teeth, frequent spasms, and the usual symptoms of tetanus. She stoutly denied any possible wound or thorn, but after very careful examination my Hospital Assistant found a small piece of wood in a suppurating cavity under the nail of one great toe. This was excised and the wound thoroughly cauterized. She was put on the same treatment, chloral and bromide every hour till drowsy, and to be continued according to its effects. She improved a little for two days, the spasms being reduced from half-hourly to two-hourly, but died on April 11th in a severe paroxysm. 1 have to thank 2nd class Hospital Assistant Ramanjulu and 1st class Hospital Assistant Kuppusawmy Pillay for these notes and the care and attention they bestowed on the patients.
[Aug.
1894.
