A NEW DIAGNOSTIC SIGN IN TYPHOID FEVER.
July, 1889.J
PRESIDENCY GENERAL HOSPITAL.
)
AlexanderMain, aged 17 years,a stowaway,
brought
to
the General Hospital, with symp011 the 15th June, 1888.
toms of tetanus,
History of case.?While working in the lower hold, he became suddenly unwell, whereupon he proceeded to the forecastle, and there fell in a fit, foaming at the mouth, and with involun-
tary contractions of his limbs. The previous day the last phalanx of the little finger of his left hand had got jammed while he was closing a large iron pot. Condition on admission.?The nail of the injured finger was blue, and the surrounding soft parts swollen and inflamed. Complained of severe pain in the loins, was suffering from frequent tetanic spasms, jaws stiff, sternomastoids not rigid. Treatment.?On the
evening
of
patient's
patieut complaiued of pain in the wouud; a sleeping draught. 14th.?Wound looking healthy. Ordered to be kept constantly wet with lotio. hydr. per-
ordered
TWO CASES OF TRAUMATIC TETANUS.
was
209
ad-
mission, Dr. Comins amputated the injured finger at the metacarpophalangeal articulation. 16th.?The patient had beeu quiet since the
operation, under the influence of chloral and bromide of potassium, until 3-30 p.m., to-day, Later in the when the spasms returned. evening the spasms became even more frequent and intense than they had been before the Severe pain in the wound, and a operation. " tearing" pain in the region of diaphragm. Two silver sutures that appeared to be tight were removed. 17th.?Had very few spasms during the night, and felt the wound much easier since the removal Still getting chloral and of the sutures. bromide of potassium, aud bowels kept freely open. 18*/i.?Had only one spasm during the previous night. Wound was 28th.?No return of spasms. now cicatrised. The patient left hospital, on the 6th of July, cured. I. W., European, aged 32 years, was admitted in Dr. Mullen's ward, at the General Hospital, on the 13th of October, 1888, suffering from an extensive lacerated wound of the fore part of the right foot, caused by a saw in motion. Nearly all the toes had been torn away, and some of the meta-tarsal bones were fractured. Under chloroform, all the lacerated tissues were removed, aud the meta-tarsal bones of the three middle toes nipped off behind the points of fracture. The little toe was left, although its phalanges were fractured, and half the first phalanx of the big toe. When stitched over the wound, the skin, which was torn iuto slip3 and shreds, formed a sort of patch work. The wound was dressed antiseptically. Evening? The dressings were blood-staiued, aud the
Temperature 98? F. Vesp.?Temperature 99?.
chlor.
15th.?Slight pain
No in wound.
pain
normal.
16th.?Temperature 100? ing just below little toe.
F.
in foot.
Temperature
Slough separat-
22nd.?Wound clean and granulating. Patient apparently doing well. 26th.?Temperature normal. Wound clean and healthy-looking. 27th.?Complains of stiffness of the jaws, and slight paiu in the epigastrium. Ordered chloral aud bromide of potassium (grs. xx of each) at bed time. 29th.?The same. Ordered the above draught twice a day. Vesp.?Complains of difficulty in swallowing. Ordered that the draught be repeated at bed time ; also two cathartic pills. 30th.?Stiffness of the jaws the same, but no difficulty in swallowing. Feels weak. ls? November.?Stiffness of jaws increased somewhat, and has a feeling of constriction in the throat when he swallows. Lin. Opii aud fomentations to jaws ordered. 3rd.?The same, but feels weaker, and perspires very much when pressure is applied over the wound. Feels a sharp pain in a spot corresponding to divided end of one of meta-tarsal bones. Wound granulating aud healthy-looking. 7th?Wouud not quite healed yet. Feels
stronger.
Suffered from painful spasms of diaphragm the night. Gets slight twitching of the muscles of the affected foot occasionally. Chloral and bromide of potassium mixture repeated every four hours.
during
26tli.?Wound
quite cicatrised.
Stiffness of
gone. Walks about on crutches. 4th December.?Discharged cured,
jaws
July, 1889.J
PRESIDENCY GENERAL HOSPITAL.
)
AlexanderMain, aged 17 years,a stowaway,
brought
to
the General Hospital, with symp011 the 15th June, 1888.
toms of tetanus,
History of case.?While working in the lower hold, he became suddenly unwell, whereupon he proceeded to the forecastle, and there fell in a fit, foaming at the mouth, and with involun-
tary contractions of his limbs. The previous day the last phalanx of the little finger of his left hand had got jammed while he was closing a large iron pot. Condition on admission.?The nail of the injured finger was blue, and the surrounding soft parts swollen and inflamed. Complained of severe pain in the loins, was suffering from frequent tetanic spasms, jaws stiff, sternomastoids not rigid. Treatment.?On the
evening
of
patient's
patieut complaiued of pain in the wouud; a sleeping draught. 14th.?Wound looking healthy. Ordered to be kept constantly wet with lotio. hydr. per-
ordered
TWO CASES OF TRAUMATIC TETANUS.
was
209
ad-
mission, Dr. Comins amputated the injured finger at the metacarpophalangeal articulation. 16th.?The patient had beeu quiet since the
operation, under the influence of chloral and bromide of potassium, until 3-30 p.m., to-day, Later in the when the spasms returned. evening the spasms became even more frequent and intense than they had been before the Severe pain in the wound, and a operation. " tearing" pain in the region of diaphragm. Two silver sutures that appeared to be tight were removed. 17th.?Had very few spasms during the night, and felt the wound much easier since the removal Still getting chloral and of the sutures. bromide of potassium, aud bowels kept freely open. 18*/i.?Had only one spasm during the previous night. Wound was 28th.?No return of spasms. now cicatrised. The patient left hospital, on the 6th of July, cured. I. W., European, aged 32 years, was admitted in Dr. Mullen's ward, at the General Hospital, on the 13th of October, 1888, suffering from an extensive lacerated wound of the fore part of the right foot, caused by a saw in motion. Nearly all the toes had been torn away, and some of the meta-tarsal bones were fractured. Under chloroform, all the lacerated tissues were removed, aud the meta-tarsal bones of the three middle toes nipped off behind the points of fracture. The little toe was left, although its phalanges were fractured, and half the first phalanx of the big toe. When stitched over the wound, the skin, which was torn iuto slip3 and shreds, formed a sort of patch work. The wound was dressed antiseptically. Evening? The dressings were blood-staiued, aud the
Temperature 98? F. Vesp.?Temperature 99?.
chlor.
15th.?Slight pain
No in wound.
pain
normal.
16th.?Temperature 100? ing just below little toe.
F.
in foot.
Temperature
Slough separat-
22nd.?Wound clean and granulating. Patient apparently doing well. 26th.?Temperature normal. Wound clean and healthy-looking. 27th.?Complains of stiffness of the jaws, and slight paiu in the epigastrium. Ordered chloral aud bromide of potassium (grs. xx of each) at bed time. 29th.?The same. Ordered the above draught twice a day. Vesp.?Complains of difficulty in swallowing. Ordered that the draught be repeated at bed time ; also two cathartic pills. 30th.?Stiffness of the jaws the same, but no difficulty in swallowing. Feels weak. ls? November.?Stiffness of jaws increased somewhat, and has a feeling of constriction in the throat when he swallows. Lin. Opii aud fomentations to jaws ordered. 3rd.?The same, but feels weaker, and perspires very much when pressure is applied over the wound. Feels a sharp pain in a spot corresponding to divided end of one of meta-tarsal bones. Wound granulating aud healthy-looking. 7th?Wouud not quite healed yet. Feels
stronger.
Suffered from painful spasms of diaphragm the night. Gets slight twitching of the muscles of the affected foot occasionally. Chloral and bromide of potassium mixture repeated every four hours.
during
26tli.?Wound
quite cicatrised.
Stiffness of
gone. Walks about on crutches. 4th December.?Discharged cured,
jaws
