There seems to be little doubt that the
thermometer, though
may be relied upon considerably in the treatment of tetanus ; it fails us when the muscles of respiration
not a certain
guide,
are
thrown into
but,
rule, it temperature
the
as
a
a
state of almost continuous tetanic spasm;
seems
content ourselves with
evening,
so long as the thermometer shows patient's body to be under 101?, we may the ordinary forty grains of chloral every
that
of the
however severe the tetanic fits may be. If the merbeyond 101?, there is danger ahead, and a second dose
cury rises
of chloral will be necessary in the daytime. Should the temperbody reach 103?, life is in imminent danger.
ature of the
TETANUS AND ITS TREATMENT. We year 1871
published
in
our
January, June,
and
July
numbers of last
series of twenty cases of tetanus, treated from June to June 1872, in the Calcutta Native Hospital; of these
a
twenty instances of tetanus, no less that seventeen recovered?a result probably unprecedented in the annals of the disease. The Practitioner for November contains
a paper on the plan of adopted in these cases, and also some general remarks on the subject of tetanus, which we feel justified in recapitulating on this occasion. On referring to tho cases, it will be noticed that a uniform plan of treatment was consistently followed throughout them all. It consisted in administering forty grains of tlio hydrate of chloral (to an adult) at bedtime, and in severe cases, the tcmperaturo of tho body rising to upwards of 101?, an additional thirty grains of chloral was given at midday. The patients were made to swallow regularly every four hours, night and day, some four ounces of milk, one egg being mixed with the milk, morning, noon, and evening; if tho pulse indicated great "Weakness, beef-tea and brandy Avero substituted for the milk. Milk and eggs, however, with arrowroot, as tho patient improves, is tho diet which was uniformly ordered; it may bo
treatment
for
consecutive days. The urgency of tho very considerable among some of these patients, sufficiently so as to make a medical man unaccustomed
twenty
symptoms
quite
or
twenty-five
was
to see many cases of tetanus imagine that some method must bo to relievo tho violence of tho tetanic spasms beyond
adopted giving a
few
grains
of chloral once or twice
a
day; nevertheless
the results abovo referred to show very plainly that, among tho natives of this part of India, the tendency of patients suffer-
ing from
tetanus is to recover, if
and enabled to procure
sleep by
they
means
aro
only sufficiently
of chloral.
fed
There seems to be good reason for opposing the frequent repetition of doses of chloral in tetanus. It does not follow that, because a dose of ten or twenty grains will not put a patient to sleep, we are to repeat the medicine every three or four hours till it produces its effect; rather allow time for the drug to pass out of the system, or become otherwise disposed of before again administering it, otherwise the chloral or its derivatives may accumulate in the blood, and ultimately poison the patient. In fact, some cases of tetanus are hopeless from the first; the intensity of the spasms, especially of the muscles under control of the nerves proceeding from the medulla, and the rapid rise in the temperature of the patient's body being the earliest and most prominent feature of the disease in dangerous cases. Under these circumstances, calabar bean, as recommended by Dr. T. K. Fraser, affords the patient the best, though a very poor, hope of recovery. But a considerable number of cases will get well, if only treated according to the dictates of common sense. These patients should be kept in a cool room shaded from the light, and absolutely at rest. They must be fed regularly?a task frequently requiring a considerable amount of patience, both on the part of the nurse and the sick person. Lastly, the patient should be put to sleep for some seven or eight hours in the twenty-four by means of the hydrate of chloral; and if the temperature of his body rises to 101?*o or to 102?, the sleeping draught must be repeated in the daytime, and an extra quantity of food administered in the shape of beef-tea and brandy.
thermometer, though
may be relied upon considerably in the treatment of tetanus ; it fails us when the muscles of respiration
not a certain
guide,
are
thrown into
but,
rule, it temperature
the
as
a
a
state of almost continuous tetanic spasm;
seems
content ourselves with
evening,
so long as the thermometer shows patient's body to be under 101?, we may the ordinary forty grains of chloral every
that
of the
however severe the tetanic fits may be. If the merbeyond 101?, there is danger ahead, and a second dose
cury rises
of chloral will be necessary in the daytime. Should the temperbody reach 103?, life is in imminent danger.
ature of the
TETANUS AND ITS TREATMENT. We year 1871
published
in
our
January, June,
and
July
numbers of last
series of twenty cases of tetanus, treated from June to June 1872, in the Calcutta Native Hospital; of these
a
twenty instances of tetanus, no less that seventeen recovered?a result probably unprecedented in the annals of the disease. The Practitioner for November contains
a paper on the plan of adopted in these cases, and also some general remarks on the subject of tetanus, which we feel justified in recapitulating on this occasion. On referring to tho cases, it will be noticed that a uniform plan of treatment was consistently followed throughout them all. It consisted in administering forty grains of tlio hydrate of chloral (to an adult) at bedtime, and in severe cases, the tcmperaturo of tho body rising to upwards of 101?, an additional thirty grains of chloral was given at midday. The patients were made to swallow regularly every four hours, night and day, some four ounces of milk, one egg being mixed with the milk, morning, noon, and evening; if tho pulse indicated great "Weakness, beef-tea and brandy Avero substituted for the milk. Milk and eggs, however, with arrowroot, as tho patient improves, is tho diet which was uniformly ordered; it may bo
treatment
for
consecutive days. The urgency of tho very considerable among some of these patients, sufficiently so as to make a medical man unaccustomed
twenty
symptoms
quite
or
twenty-five
was
to see many cases of tetanus imagine that some method must bo to relievo tho violence of tho tetanic spasms beyond
adopted giving a
few
grains
of chloral once or twice
a
day; nevertheless
the results abovo referred to show very plainly that, among tho natives of this part of India, the tendency of patients suffer-
ing from
tetanus is to recover, if
and enabled to procure
sleep by
they
means
aro
only sufficiently
of chloral.
fed
There seems to be good reason for opposing the frequent repetition of doses of chloral in tetanus. It does not follow that, because a dose of ten or twenty grains will not put a patient to sleep, we are to repeat the medicine every three or four hours till it produces its effect; rather allow time for the drug to pass out of the system, or become otherwise disposed of before again administering it, otherwise the chloral or its derivatives may accumulate in the blood, and ultimately poison the patient. In fact, some cases of tetanus are hopeless from the first; the intensity of the spasms, especially of the muscles under control of the nerves proceeding from the medulla, and the rapid rise in the temperature of the patient's body being the earliest and most prominent feature of the disease in dangerous cases. Under these circumstances, calabar bean, as recommended by Dr. T. K. Fraser, affords the patient the best, though a very poor, hope of recovery. But a considerable number of cases will get well, if only treated according to the dictates of common sense. These patients should be kept in a cool room shaded from the light, and absolutely at rest. They must be fed regularly?a task frequently requiring a considerable amount of patience, both on the part of the nurse and the sick person. Lastly, the patient should be put to sleep for some seven or eight hours in the twenty-four by means of the hydrate of chloral; and if the temperature of his body rises to 101?*o or to 102?, the sleeping draught must be repeated in the daytime, and an extra quantity of food administered in the shape of beef-tea and brandy.
