233

Aug. 7th.—Bowels still confined ; patient had had no sleep;was very restless ; had a very anxious expression ; could bearno noise ; had no pain, and was still in a cold, clammysweat. Instead of the ice, I ordered mustard-and-vinegarplasters to be applied along the whole length of the spine, tobe followed by bags of heated salt, and dropped about twodrops of croton oil between his teeth.8th.-Bowels moved early this morning; with this ex-

ception, patient about the same as yesterday. As he hadhad no sleep, I administered an anodyne injection.9th.-Patient about the same ; no pain; in a cold sweat

still. Besides the beef-tea injections, tried to get him toswallow a little milk, but he was unable.

10th.—Slight improvement in swallowing.llth. - Is still stiff and arched ; is getting emaciated;

moans a great deal; makes no complaint of pain ; has no wishto take his milk; has a very depressed appearance. Abdomenvery hard ; to be rubbed with turpentine, and bags of hotsalt to be applied. Body covered with cold sweat. Feet verycold ; wrapped in flannel. Hot-water bottles to be continued,and also to be placed between and at the sides of the legs.12th.-Back still stiff and arched; body covered with a

profuse cold sweat; has no pain; great thirst; swallowsbetter; has had no sleep; lower limbs and body very cold.Body covered with hot linseed-meal poultices. Ordered beef-tea and brandy, and chloral hydrate and bromide of potassiummixture.13th.-As I was engaged from home, the patient was seen

by my father, who ordered the spine to be well blistered anda jalap draught to be taken.14th.-Patient seems better. Bowels have been opened.

Swallows very much better; back still stiff and arched.15th.-Much better; asks for nourishment. Back still

stiff; has still cold sweats.16th to 19th.-Still improves; voice stronger; countenance

not so anxious ; swallowing power fully recovered; back notso stiff; eats his food greedily.20th. - Patient not so well; body and ankles swollen.

Ordered a croton-oil pill, and, as he is restless, an anodynedraught.

21st.—Continually asking for food. Back not nearly sostiff; cold sweats leaving him ; has slept well. Ordered amixture of the tincture of muriate of iron.

24th.—Much better. Passes more water, cold sweatinghaving entirely left him; body soft; swelling has left bodyand ankles, and he has lost all stiffness. To go on withthe iron mixture.27th.-Still improving ; eats greedily.30th.-Nearly well.Sept. 3rd. -Patient up and dressed, and rapidly regaining

his strength.Boston, Lincolnshire.

CASE OF TRAUMATIC TETANUS;RECOVERY.

BY ARCHIBALD LAWSON, M.R.C.S. LOND.,PROFESSOR OF SURGERY, HALIFAX MEDICAL SCHOOL.

THE following case is probably sufficiently interesting tobe placed on record.G. S-, a fisherman’s son, ten years of age, living at

Sambro, a village about twenty miles from here, on August1st, whilst running barefooted, accidentally ran against ascythe, receiving a wound about two inches long on the in-step of the left foot, which implicated the extensor tendons;also another on the little toe of the same foot, nearly sever-ing the toe. He was brought to Halifax. Sutures wereinserted and the wounds -dressed. He then went home toSambro. On August 9th I saw him for the first time, andfound him in the following condition:-The. jaws were firmlylocked; the risus sardonicus well marked; whole bodystiffened with decided opisthotonos ; great difficulty inswallowing and breathing; sweating profusely ; pulse 144;temperature 103°. The wound of instep ’was granulatinghealthily, the stitches having evidently sloughed out, and asmall piece of bone was protruding from the little toe, whichI removed. The poor boy was literally covered withpoultices, all the windows religiously closed, and a fire inthe stove, although it was a very hot day in August. If

left in this condition much longer the boy must have soondied. Severe spasms were induced by the slightest move-ment. I gave him immediately fourteen grains of hydrateof chloral, and ordered eight grains to be given every hour,with a mustard poultice the whole length of spine, and milkto be given every time he took the chloral, which, however,he could only suck through the teeth, and the difficulty inswallowing made it no easy matter. I remained all nightadministering the chloral and milk myself.August 10th. -Pulse 120 ; temperature 100°. No relief of

trismus. Body still stiff, but spasms not so frequent or

violent. Ordered a continuance of the chloral, eight grainsevery hour, with milk, and dressed the wound with carbolicacid and oil (1 to 20).llth.-Worse again, boy refusing both milk and chloral.

Temperature 101°; pulse 136, very weak. Profuse sweating ;trismus continuing with opisthotonos. I remained fourhours, giving eight grains of chloral every hour ; he alsotook about half a pint of milk during this time.

14th.—Doing fairly well. Pulse 116 ; temperature 990.But few spasms; trismus slightly relieved; spine still rigid,but the legs could with ease be bent upon the abdomen.Continues chloral, but takes very little nourishment. Bowelsrelieved by enema ; passed quantities of flatus. Woundshealing well.

17th.—Had been doing well since last visit, but boy refusedchloral, and the spasm had increased again. Gave sixteengrains of chloral with marked relief, and to continue eightgrains every two hours; still taking the milk. Is very weak.20th.-Decidedly better. Pulse 98; temperature 99°.

Trismus and opisthotonos both relaxing. Boy still fightsagainst both nourishment and medicine. To take ten grainsof chloral every three hours.23rd.-Scarcely any spasms except when moved, even then

slight. Pulse 88; temperature 99°. Could pass my fore-finger into the mouth.From this time he recovered rapidly; the chloral was con-

tinued in small doses for a week, and then only given atnight. On Sept. 7th he was able to get about.

This case is interesting, I think, in that it was a veryacute case, in which recovery is rare ; that no other drugexcept chloral was administered; no stimulants; no nourish-ment except milk, and very little of that, from Aug. 9thuntil 23rd.

Halifax, Nova Scotia.

A MirrorOF

HOSPITAL PRACTICE,BRITISH AND FOREIGN.

Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morbor"aet dissectionum historias, tum aliorum, tum proprias collect as habere, etinter se compare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Procomium.

UNIVERSITY COLLEGE HOSPITAL.A SERIES OF CASES OF TUMOUR OF THE FEMALE BREAST ;

REMARKS.

(Under the care of Mr. JOHN MARSHALL.)THE following notes, for which we are indebted to Mr.

Gadsby, late house-surgeon, indicate the chief diagnosticcharacteristics of a few forms of tumour of the breast Takenas a whole, the series is exceedingly interesting and instruc-tive from a clinical point of view; but the third case hasquite a special pathological value. The histological natureof the cysts, together with the character of the delicate- alaa-.thelium lining them, bespoke their lymphatic origin, althoughthe history and the external manifestations pointed rather tocancer. Some explanatory and elucidatory remarks precede’the notes of each case.CASE 1. Simple adeno-fibroma; removal ; recovery.—The

elements in the diagnosis in this case were as follows : Thepatient was a healthy young woman who had never beenpregnant ; the tumour was freely movable in the gland-sub-stance, and had well-defined margins and a smooth surface;neither the nipple nor the adjoining lymphatic glands wereimplicated ; and, lastly, the tumour was only painful at th&