A CASE OF TRAUMATIC TETANUS Under care of Surgeon-Major T. Civil
:
RECOVERY.
J. McGann,
Surgeon, Mysore.
( Case by Hospital Assistant M. Abdul Wahais, /ail Hospital, Mysore.) Navnc, M. Siddah, ret. 54, convicted'prisoner. Date of admission to Jail, gth April 1S77. Date of admission to Hospital, 31st March 1S83.
A MIRROR OF HOSPITAL PRACTICE.
1883.]
December,
Date of discharge from Hospital, 21st May 1883Years of confinement years. 7 Period in the Jail... ,, 51^ This prisoner entered the jail in a good state of health from on the admitted into 9th April 1877, Mysore hospital this morning, complaining of severe pain and stiffness in the nape of the neck, making the motion of head difficult and painful ; said to be of one day's duration. Previous history.?States that about 5 days ago, while coming from the manufactory rooms, his left foot accidentally struck and the he fell and left side of his head slipped against the ground, thus causing a contused Wound just an inch above the outer extremity of the left eyebrow, and a large abrasion over the anterior aspect of his left forearm^ for which he attended as On the morning of the 5th an out-patient for 4 days. day after the accident, just when the stage of cicatrization was and a stiffness in the attended felt with neck, pain going on, he difficulty in swallowing. He was then admitted as an in-patient into the hospital. Conditions on admission.?There is a tonic rigidity of the muscles of lower jaw, neck, and the back, and there are also When clonic spasms of the recti muscles of the abdomen. these latter muscles become rigid they cause a severe pain near This rigidity passes on to the muscles the ensiform cartilage. of the back, increasing their already rigid state, and then to These spasms are brought on by the the lower extremities. slightest exposure to cold air, talking to, or touching the patient. The s.udden contraction of the muscles occasions the most unbearable pain, and the pain, he states, comes from the There is extreme prostration. The pulse seat of the injury. is t 20 per minute and respiration is laborious ; the skin covered Bowels constipated since yesterday. with profuse perspiration. Treatment:? ...
...
...
ft
Mag. Sulph. Aqu?e
...
Potassii Bromid. Chloral
Every
2
...
Hydratis
..
...
...
...
...
...
...
hours.
Liniment Bellad
ft
...
...
Tinct, Cannabis Ind.
Aquae
...
...
...
ft
...
...
Chloroform
...
Mft. Liniment to be rubbed to the wound.
Diet.?Milk.
...
Extras.?Milk
...
over
one
the
^ss. grs. grs.
uj
v.
^ii.
2nd.?The jaws are strongly closed and make him unable to his mouth. Spasms were frequent last night. Slept one hour. ft Potassii bromid. grs. xxv. Chloral Hydratis. grs. xx. v. Tinct. Cannabis Ind.
open
...
Aquje M.
every
2
hours.
...
...
...
...
Continue liniment.
OI. Terebinth. 01. Ricini,
Aq. Orizae Enema, st.
1f|
gii-
...
...
...
...
...
...
...
^ss
Liniment Bellad.
...
Chloroformi M.ft. on
Liniment to be
the nope of the neck,
rubbed
over
...
...
...
...
?i.
gij.
the spinal column and
grs. xxx, grs, xxv. x.
^
..
Treatment :? R Mag, Sulph.
Aq* R
_
...
...
'r
M.ft, Haustus st. Potassii Bromid. Chloral Hydratis Tinct. Cannabis Ind
Aq.
iJ!?
gSs.
...
a
v:
:
...
grs. xxxv. grs, xxv.
...
...
...
H|^
...
...
...
M Every 2nd hour. Extracti Carnis
...
...
...
...
...
xii.
5ij
?"
Zij qs.
^vi
...
M.ft, Mist ^2 part every 2nd hour. Continue liniment and fomentation. 16th.?He is a little better. Slept 5 hours last night. Bowels moved once
yesterday.
17th.?Tie is better. 18th.?He says on waking up this morning the pain and stiffness in the neck became so extremely severe that he found himself almost unable to move his head. Slept 5 hours last night. Bowels moved once last night. 19th.?He is a little better. 20th.?Slept 4 hours last night. Bowels moved twice yesterday and once last night. 21st.?The rigidity and contraction of muscles are less frequent and mild in their forms. Slept 5 hours last night. Bowels moved once yesterday and once this morning. Potassii Bromid. Chloral Hydratis. Tinct. Cannabis, Ind.
Aquae
...
M.ft. haustus every R
Qi
M. ft. Continue treatment as yesterday. ifth.?Spasms were less severe yesterday and last night. Bowels moved 3 times after enema ; slept 4 hours last night. 5th.?Bowels moved once last night. Complains of a sense of stiffness and tightness in the lower jaw, neck, and along the spinal column. Slept 3 hours last night. ft
...
_
_
R
...
...
...
^
yd,?Slept 3 hours last night. Bowels not moved since yesterday. A partial remission of the symptoms takes place every 15 or 20 minutes, but they are renewed with increased severity and pain. ft
...
Aq Tepid
-A.
seer.
???
...
...
...
Sodii Chlord.
night. purgative.
...
...
..
R
M.
^ii.
Potassii Bromid. Chloral Hydratis Tinct. Cannabis Ind.
Aq. 3ij. M. Every 2nd hour. Continue liniment. >]th. Spasms were less severe, slept 4 hours last night. Bowels moved once yesterday. 8//*.?The rigidity of the muscles is constant, but suddenly Bowels moved once yesterday increases in contraction. once last night Slept 4 hours last night. 9///.?lie is a little better. 10th. Complains of pain in the chest and in all the muscles of the trunk. Bowels moved twice yesterday. Continue treatment. Poppy fomentation twice a day. j 1 th.?Spasms in the region of the diaphragm are very frequent. Slept 4 hours last night. Bowels moved once yester, day. 12th. Complains of pain in the lowei jaw and in the nape of the neck. Slept 5 hours last night. Bowels moved once last night. 13th.?Spasms were less .severe last night. Slept 5 hours. Bowels moved once yesterday. 14tli. He is a little better. 15th. Complains of difficulty in mastication and in swallowing his food, Bowels not moved since yesterday. Slept 4 hours,
?;
rst April-?Spasms are said' to have been verv violent last Slept only two hours. Bowels moved once after
...
R
xx. xv.
spine ; simple dressing
...
6th.?Complains of pain in the ensiform cartilage and thence extending to the back. Had no sleep last night owing to the continuous rigidity and frequent contraction of the muscles of lower jaws and neck. Bowels moved once yesterday.
Mst.
gi.
343
...
...
...
3rd
...
hour.
Extract Carnis
Aq. Tepid
...
]/e part
xii.
gij 51J'
...
.
grs. xxxv. grs, xxv.
...
...
Sodii Chlorid. M.ft mist. R
...
...
...
every
Liniment Bellad.
qs.
5jvi.
4th hour.
...
...
Chloroform
...
zi
gii
M.ft. Liniment to be rubbed frequently. Poppy fomentation twice a day. 22nd.?He is better. 23rd.?Spasms are mild in their form, and occ\\f after a long interval. Bowels moved once yesterday. 24th.?He slept 5 hours last night.
"
26th.?He is much better.
"
"
THE INDIAN MEDICAL GAZETTE.
344
Bowels moved once last
30th.?He is improving. this morning. ist May, 1SS3.?He is night.
night
and
once
Treatment
Bromid.
Chloral Hydratis Tinct. Cannabis Ind.
Aq. M.ft. ft
Slept
las'
...
haustus;
every
4th
...
...
...
...
...
...
...
xx.
xii.
?ss.
hour.
Extract Carnis,
^q.
xxx.
grs. grs.
...
...
Sodii Chlorid.
Tepid.
gii
...
...
...
...
...
q. s.
^ii
t)
Mist. ft. 5^th part every ment and fomentation.
hour.
4th
2nd.?Spasms were mild and were yesterday. Slept 6 hours last night. yesterday and once last night. 3rd.? Bowels moved twice last night. to 5 a. M. last night. 4th.?Slept 8 hours last night. 7th. Complains of pain in the nape of tion
not
6 hours
:?
Potassii
R
much better.
Continue lini-
of very short duraBowels moved once
Slept
from II P. M.
the neck. He canBowels moved once last
open his mouth to full extent.
night. gth.?He is improving. 13th.?His general health is improving. 13th. ?His general health progressing steadily. 17th.?Bowels not moved since yesterday. Complains pain in the lower jaw.
of
Treatment:? ft
Potassii Bromid. Chloral Hydratis Tinct. Cannabis. Ind.
Aq,
...
...
...
...
...
....
???
'
???
???
M.ft. haustus every 6th hour. ft
Extract Carnis.
...
-flj^ ^ss'
gij.
Sodii Chlorid.
...
...
q.
Aq. Tepid
...
...
?vi.
Mist ft. ft
...
grs. xx. grs. xv. xii.
:
...
one-sixth part every
Liniment Bellad. Chlorofornii
4th hour.
...
...
sj.
...
...
...
Jj. ?i.
to be rubbed frequently over the Liniment ft. painful part. iSth.?Slept well last night, pain in the lower jaw is a little betters. Bowels moved once yesterday. igth. ?He could open his mouth to full extent, pain in the neck and lower jaw is much better. Slept well last night. Bowels regular. 20th.? His general health is much improved. Slept well last night. Bowels regular?appetite good. Treatment
:?
Potassii. Bromid. Chloral Hydratis Tinct. Cannabis Ind. .
Aq.
Extract. Carnis
a
...
...
...
???
grs. xv. grs. xv.
xii,
gss.
day. ...
Sodii Chlorid.
Aq., Tepid
...
...
???
...
M.ft. haustus twice ft
...
...
..
...
...
...
...
gii. qs.
gvi.
M.ft. mist one-sixth part every 4th hour. ft
Liniment Bellad. to be rubbed well
painful part. 2ist.?Discharged well Mysore
20th
from the
Jail Hospital, \ \
Junei 1SS3.
hospital.
frequently
over
the
[December, 1883.
:
RECOVERY.
J. McGann,
Surgeon, Mysore.
( Case by Hospital Assistant M. Abdul Wahais, /ail Hospital, Mysore.) Navnc, M. Siddah, ret. 54, convicted'prisoner. Date of admission to Jail, gth April 1S77. Date of admission to Hospital, 31st March 1S83.
A MIRROR OF HOSPITAL PRACTICE.
1883.]
December,
Date of discharge from Hospital, 21st May 1883Years of confinement years. 7 Period in the Jail... ,, 51^ This prisoner entered the jail in a good state of health from on the admitted into 9th April 1877, Mysore hospital this morning, complaining of severe pain and stiffness in the nape of the neck, making the motion of head difficult and painful ; said to be of one day's duration. Previous history.?States that about 5 days ago, while coming from the manufactory rooms, his left foot accidentally struck and the he fell and left side of his head slipped against the ground, thus causing a contused Wound just an inch above the outer extremity of the left eyebrow, and a large abrasion over the anterior aspect of his left forearm^ for which he attended as On the morning of the 5th an out-patient for 4 days. day after the accident, just when the stage of cicatrization was and a stiffness in the attended felt with neck, pain going on, he difficulty in swallowing. He was then admitted as an in-patient into the hospital. Conditions on admission.?There is a tonic rigidity of the muscles of lower jaw, neck, and the back, and there are also When clonic spasms of the recti muscles of the abdomen. these latter muscles become rigid they cause a severe pain near This rigidity passes on to the muscles the ensiform cartilage. of the back, increasing their already rigid state, and then to These spasms are brought on by the the lower extremities. slightest exposure to cold air, talking to, or touching the patient. The s.udden contraction of the muscles occasions the most unbearable pain, and the pain, he states, comes from the There is extreme prostration. The pulse seat of the injury. is t 20 per minute and respiration is laborious ; the skin covered Bowels constipated since yesterday. with profuse perspiration. Treatment:? ...
...
...
ft
Mag. Sulph. Aqu?e
...
Potassii Bromid. Chloral
Every
2
...
Hydratis
..
...
...
...
...
...
...
hours.
Liniment Bellad
ft
...
...
Tinct, Cannabis Ind.
Aquae
...
...
...
ft
...
...
Chloroform
...
Mft. Liniment to be rubbed to the wound.
Diet.?Milk.
...
Extras.?Milk
...
over
one
the
^ss. grs. grs.
uj
v.
^ii.
2nd.?The jaws are strongly closed and make him unable to his mouth. Spasms were frequent last night. Slept one hour. ft Potassii bromid. grs. xxv. Chloral Hydratis. grs. xx. v. Tinct. Cannabis Ind.
open
...
Aquje M.
every
2
hours.
...
...
...
...
Continue liniment.
OI. Terebinth. 01. Ricini,
Aq. Orizae Enema, st.
1f|
gii-
...
...
...
...
...
...
...
^ss
Liniment Bellad.
...
Chloroformi M.ft. on
Liniment to be
the nope of the neck,
rubbed
over
...
...
...
...
?i.
gij.
the spinal column and
grs. xxx, grs, xxv. x.
^
..
Treatment :? R Mag, Sulph.
Aq* R
_
...
...
'r
M.ft, Haustus st. Potassii Bromid. Chloral Hydratis Tinct. Cannabis Ind
Aq.
iJ!?
gSs.
...
a
v:
:
...
grs. xxxv. grs, xxv.
...
...
...
H|^
...
...
...
M Every 2nd hour. Extracti Carnis
...
...
...
...
...
xii.
5ij
?"
Zij qs.
^vi
...
M.ft, Mist ^2 part every 2nd hour. Continue liniment and fomentation. 16th.?He is a little better. Slept 5 hours last night. Bowels moved once
yesterday.
17th.?Tie is better. 18th.?He says on waking up this morning the pain and stiffness in the neck became so extremely severe that he found himself almost unable to move his head. Slept 5 hours last night. Bowels moved once last night. 19th.?He is a little better. 20th.?Slept 4 hours last night. Bowels moved twice yesterday and once last night. 21st.?The rigidity and contraction of muscles are less frequent and mild in their forms. Slept 5 hours last night. Bowels moved once yesterday and once this morning. Potassii Bromid. Chloral Hydratis. Tinct. Cannabis, Ind.
Aquae
...
M.ft. haustus every R
Qi
M. ft. Continue treatment as yesterday. ifth.?Spasms were less severe yesterday and last night. Bowels moved 3 times after enema ; slept 4 hours last night. 5th.?Bowels moved once last night. Complains of a sense of stiffness and tightness in the lower jaw, neck, and along the spinal column. Slept 3 hours last night. ft
...
_
_
R
...
...
...
^
yd,?Slept 3 hours last night. Bowels not moved since yesterday. A partial remission of the symptoms takes place every 15 or 20 minutes, but they are renewed with increased severity and pain. ft
...
Aq Tepid
-A.
seer.
???
...
...
...
Sodii Chlord.
night. purgative.
...
...
..
R
M.
^ii.
Potassii Bromid. Chloral Hydratis Tinct. Cannabis Ind.
Aq. 3ij. M. Every 2nd hour. Continue liniment. >]th. Spasms were less severe, slept 4 hours last night. Bowels moved once yesterday. 8//*.?The rigidity of the muscles is constant, but suddenly Bowels moved once yesterday increases in contraction. once last night Slept 4 hours last night. 9///.?lie is a little better. 10th. Complains of pain in the chest and in all the muscles of the trunk. Bowels moved twice yesterday. Continue treatment. Poppy fomentation twice a day. j 1 th.?Spasms in the region of the diaphragm are very frequent. Slept 4 hours last night. Bowels moved once yester, day. 12th. Complains of pain in the lowei jaw and in the nape of the neck. Slept 5 hours last night. Bowels moved once last night. 13th.?Spasms were less .severe last night. Slept 5 hours. Bowels moved once yesterday. 14tli. He is a little better. 15th. Complains of difficulty in mastication and in swallowing his food, Bowels not moved since yesterday. Slept 4 hours,
?;
rst April-?Spasms are said' to have been verv violent last Slept only two hours. Bowels moved once after
...
R
xx. xv.
spine ; simple dressing
...
6th.?Complains of pain in the ensiform cartilage and thence extending to the back. Had no sleep last night owing to the continuous rigidity and frequent contraction of the muscles of lower jaws and neck. Bowels moved once yesterday.
Mst.
gi.
343
...
...
...
3rd
...
hour.
Extract Carnis
Aq. Tepid
...
]/e part
xii.
gij 51J'
...
.
grs. xxxv. grs, xxv.
...
...
Sodii Chlorid. M.ft mist. R
...
...
...
every
Liniment Bellad.
qs.
5jvi.
4th hour.
...
...
Chloroform
...
zi
gii
M.ft. Liniment to be rubbed frequently. Poppy fomentation twice a day. 22nd.?He is better. 23rd.?Spasms are mild in their form, and occ\\f after a long interval. Bowels moved once yesterday. 24th.?He slept 5 hours last night.
"
26th.?He is much better.
"
"
THE INDIAN MEDICAL GAZETTE.
344
Bowels moved once last
30th.?He is improving. this morning. ist May, 1SS3.?He is night.
night
and
once
Treatment
Bromid.
Chloral Hydratis Tinct. Cannabis Ind.
Aq. M.ft. ft
Slept
las'
...
haustus;
every
4th
...
...
...
...
...
...
...
xx.
xii.
?ss.
hour.
Extract Carnis,
^q.
xxx.
grs. grs.
...
...
Sodii Chlorid.
Tepid.
gii
...
...
...
...
...
q. s.
^ii
t)
Mist. ft. 5^th part every ment and fomentation.
hour.
4th
2nd.?Spasms were mild and were yesterday. Slept 6 hours last night. yesterday and once last night. 3rd.? Bowels moved twice last night. to 5 a. M. last night. 4th.?Slept 8 hours last night. 7th. Complains of pain in the nape of tion
not
6 hours
:?
Potassii
R
much better.
Continue lini-
of very short duraBowels moved once
Slept
from II P. M.
the neck. He canBowels moved once last
open his mouth to full extent.
night. gth.?He is improving. 13th.?His general health is improving. 13th. ?His general health progressing steadily. 17th.?Bowels not moved since yesterday. Complains pain in the lower jaw.
of
Treatment:? ft
Potassii Bromid. Chloral Hydratis Tinct. Cannabis. Ind.
Aq,
...
...
...
...
...
....
???
'
???
???
M.ft. haustus every 6th hour. ft
Extract Carnis.
...
-flj^ ^ss'
gij.
Sodii Chlorid.
...
...
q.
Aq. Tepid
...
...
?vi.
Mist ft. ft
...
grs. xx. grs. xv. xii.
:
...
one-sixth part every
Liniment Bellad. Chlorofornii
4th hour.
...
...
sj.
...
...
...
Jj. ?i.
to be rubbed frequently over the Liniment ft. painful part. iSth.?Slept well last night, pain in the lower jaw is a little betters. Bowels moved once yesterday. igth. ?He could open his mouth to full extent, pain in the neck and lower jaw is much better. Slept well last night. Bowels regular. 20th.? His general health is much improved. Slept well last night. Bowels regular?appetite good. Treatment
:?
Potassii. Bromid. Chloral Hydratis Tinct. Cannabis Ind. .
Aq.
Extract. Carnis
a
...
...
...
???
grs. xv. grs. xv.
xii,
gss.
day. ...
Sodii Chlorid.
Aq., Tepid
...
...
???
...
M.ft. haustus twice ft
...
...
..
...
...
...
...
gii. qs.
gvi.
M.ft. mist one-sixth part every 4th hour. ft
Liniment Bellad. to be rubbed well
painful part. 2ist.?Discharged well Mysore
20th
from the
Jail Hospital, \ \
Junei 1SS3.
hospital.
frequently
over
the
[December, 1883.
