CASE OF TRAUMATIC TETANUS; RECOVERY.
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233 Aug. 7th.—Bowels still confined ; patient had had no sleep; was very restless ; had a very anxious expression ; could bear no noise ; had no pain, and was still in a cold, clammy sweat. Instead of the ice, I ordered mustard-and-vinegar plasters to be applied along the whole length of the spine, to be followed by bags of heated salt, and dropped about two drops of croton oil between his teeth. 8th.-Bowels moved early this morning; with this ex- ception, patient about the same as yesterday. As he had had 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 to swallow 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 wish to take his milk; has a very depressed appearance. Abdomen very hard ; to be rubbed with turpentine, and bags of hot salt to be applied. Body covered with cold sweat. Feet very cold ; 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; swallows better; 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 potassium mixture. 13th.-As I was engaged from home, the patient was seen by my father, who ordered the spine to be well blistered and a 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 not so 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 anodyne draught. 21st.—Continually asking for food. Back not nearly so stiff; cold sweats leaving him ; has slept well. Ordered a mixture of the tincture of muriate of iron. 24th.—Much better. Passes more water, cold sweating having entirely left him; body soft; swelling has left body and ankles, and he has lost all stiffness. To go on with the 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 to be placed on record. G. S-, a fisherman’s son, ten years of age, living at Sambro, a village about twenty miles from here, on August 1st, whilst running barefooted, accidentally ran against a scythe, 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 were inserted and the wounds -dressed. He then went home to Sambro. On August 9th I saw him for the first time, and found him in the following condition:-The. jaws were firmly locked; the risus sardonicus well marked; whole body stiffened with decided opisthotonos ; great difficulty in swallowing and breathing; sweating profusely ; pulse 144; temperature 103°. The wound of instep ’was granulating healthily, the stitches having evidently sloughed out, and a small piece of bone was protruding from the little toe, which I removed. The poor boy was literally covered with poultices, all the windows religiously closed, and a fire in the stove, although it was a very hot day in August. If left in this condition much longer the boy must have soon died. Severe spasms were induced by the slightest move- ment. I gave him immediately fourteen grains of hydrate of chloral, and ordered eight grains to be given every hour, with a mustard poultice the whole length of spine, and milk to be given every time he took the chloral, which, however, he could only suck through the teeth, and the difficulty in swallowing made it no easy matter. I remained all night administering 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 grains every hour, with milk, and dressed the wound with carbolic acid 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 four hours, giving eight grains of chloral every hour ; he also took 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. Bowels relieved by enema ; passed quantities of flatus. Wounds healing well. 17th.—Had been doing well since last visit, but boy refused chloral, and the spasm had increased again. Gave sixteen grains of chloral with marked relief, and to continue eight grains every two hours; still taking the milk. Is very weak. 20th.-Decidedly better. Pulse 98; temperature 99°. Trismus and opisthotonos both relaxing. Boy still fights against both nourishment and medicine. To take ten grains of 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 at night. On Sept. 7th he was able to get about. This case is interesting, I think, in that it was a very acute case, in which recovery is rare ; that no other drug except chloral was administered; no stimulants; no nourish- ment except milk, and very little of that, from Aug. 9th until 23rd. Halifax, Nova Scotia. A Mirror OF HOSPITAL PRACTICE, BRITISH AND FOREIGN. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morbor"a et dissectionum historias, tum aliorum, tum proprias collect as habere, et inter 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 diagnostic characteristics of a few forms of tumour of the breast Taken as a whole, the series is exceedingly interesting and instruc- tive from a clinical point of view; but the third case has quite a special pathological value. The histological nature of the cysts, together with the character of the delicate- alaa-. thelium lining them, bespoke their lymphatic origin, although the history and the external manifestations pointed rather to cancer. 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 : The patient was a healthy young woman who had never been pregnant ; 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 were implicated ; and, lastly, the tumour was only painful at th&
Transcript of CASE OF TRAUMATIC TETANUS; RECOVERY.
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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&
