A MIRROR OF
HOSPITAL
PRACTICE.
HOOGHLY HOSPITAL.
V
CASE OF TRAUMATIC TETANUS Under care
of
:
RECOVERY.
Asst.-Surg. Dwarkanath
Sen,
l.m.s.
Bodhai, a Hindu up-country man, aged about thirty, of tolerably sound constitution, brought for admission into the
the 3rd September last for a contused wound The patient was by occupation a khalasi attached Store Godown in connection with the Hooghly Bridge project, and met with an accident which entirely cut right through the plantar surface of the left foot from the heel to about two inches distant from the metatarso-phalangeal articulation, damaging to a great extent the muscles, the important vessels, and the nerves, and exposing in some places the He was bones that entered into the construction of the limb. detained one day by the Native Doctor in charge of the workshop, who sutured the flap to maintain it in its place, and dressed the wound with carbolic oil, and bandage to cause primary union. The disease ran its course notwithstanding all precautions taken and measures adopted to dress the wound antiseptically, and in twenty-four hours it spread and reached its height, the pain and swelling began steadily to increase, and the skin assumed all the appearances of a sloughing gangrene. Profuse suppuration set in, and the strength of the patient began gradually to decline by continued high fever, sleeplessness and disinclination for food. In five d?ys more the skin sloughed off, the discharge from the wound became fcetid and plentiful, and the patient felt seedy and irritable in his temper and became much depressed in spirit. From the 8th to 16th September the swelling and pain had gone down, the discharge became less, the ulcer showed signs of healthy granulations, appetite returned, and the patient again was cheerful and,hoped for his life. He was all along treated internally with diaphoretics :?Quinine, iron tonics, and morphia ; and externally with carbolic oil dressing, bandage and fomentation, and fed with spoon diet, milk diet, and full diets. On the evening of the 16th September the man complain* ed af pain, was rather feverish, and rejected his.food. The next
hospital of foot. the to
on
January, 1885. ]
MYMENSING DISPENSARY,
morning both his neck and jaw were stiff and painful, and he thought the symptoms would pass off in a couple of days, and wanted something to rub over the parts. Within twenty-four hours
short spasms of the back, throat and abdomen occurred, on the momentary exposure or the slight excitement the first symptoms of tetanic grin or risus sardonicus appeared, and the diagnosis became positive. The spasm spread over the limb, the abdomen became hard, and the back aiched (opisthotonos) and the jaws fixed. Difficulty in deglutition, profuse perspiration, costiveness, and impeded respiration became intense as the spasms were aggravated every day. On the first appearance of tetanic symptoms the patient was removed and kept a in separate room on a wooden cot, covered with blankets to avoid all source of excitement, to protect from cold draught, and to encourage diaphoresis. Internally he was treated with Chloral Hydrate, Pot. Bromidum, Tinct. of Cannabis Indica, and Quinine in large doses and externally with lard and daily subcutaneous injection of atropia 1-120 grains to 30 minims of water, and fed with low diet. Under this plan of treatment the symptoms began slowly to disappear and recovery was confidently hoped for, but on the 5th of this current month fever set in violently, keeping the patient awake all night and destroying his peace of mind. On the 6th a painful swelling made its appearance above the ankle-joint (left), which gradually increased and formed into an abscess, which being mature on the morning of the 7th was opened, and caused the matter to let out to the great relief of the patient. Since then all the symptoms began to disappear on
HOSPITAL
PRACTICE.
HOOGHLY HOSPITAL.
V
CASE OF TRAUMATIC TETANUS Under care
of
:
RECOVERY.
Asst.-Surg. Dwarkanath
Sen,
l.m.s.
Bodhai, a Hindu up-country man, aged about thirty, of tolerably sound constitution, brought for admission into the
the 3rd September last for a contused wound The patient was by occupation a khalasi attached Store Godown in connection with the Hooghly Bridge project, and met with an accident which entirely cut right through the plantar surface of the left foot from the heel to about two inches distant from the metatarso-phalangeal articulation, damaging to a great extent the muscles, the important vessels, and the nerves, and exposing in some places the He was bones that entered into the construction of the limb. detained one day by the Native Doctor in charge of the workshop, who sutured the flap to maintain it in its place, and dressed the wound with carbolic oil, and bandage to cause primary union. The disease ran its course notwithstanding all precautions taken and measures adopted to dress the wound antiseptically, and in twenty-four hours it spread and reached its height, the pain and swelling began steadily to increase, and the skin assumed all the appearances of a sloughing gangrene. Profuse suppuration set in, and the strength of the patient began gradually to decline by continued high fever, sleeplessness and disinclination for food. In five d?ys more the skin sloughed off, the discharge from the wound became fcetid and plentiful, and the patient felt seedy and irritable in his temper and became much depressed in spirit. From the 8th to 16th September the swelling and pain had gone down, the discharge became less, the ulcer showed signs of healthy granulations, appetite returned, and the patient again was cheerful and,hoped for his life. He was all along treated internally with diaphoretics :?Quinine, iron tonics, and morphia ; and externally with carbolic oil dressing, bandage and fomentation, and fed with spoon diet, milk diet, and full diets. On the evening of the 16th September the man complain* ed af pain, was rather feverish, and rejected his.food. The next
hospital of foot. the to
on
January, 1885. ]
MYMENSING DISPENSARY,
morning both his neck and jaw were stiff and painful, and he thought the symptoms would pass off in a couple of days, and wanted something to rub over the parts. Within twenty-four hours
short spasms of the back, throat and abdomen occurred, on the momentary exposure or the slight excitement the first symptoms of tetanic grin or risus sardonicus appeared, and the diagnosis became positive. The spasm spread over the limb, the abdomen became hard, and the back aiched (opisthotonos) and the jaws fixed. Difficulty in deglutition, profuse perspiration, costiveness, and impeded respiration became intense as the spasms were aggravated every day. On the first appearance of tetanic symptoms the patient was removed and kept a in separate room on a wooden cot, covered with blankets to avoid all source of excitement, to protect from cold draught, and to encourage diaphoresis. Internally he was treated with Chloral Hydrate, Pot. Bromidum, Tinct. of Cannabis Indica, and Quinine in large doses and externally with lard and daily subcutaneous injection of atropia 1-120 grains to 30 minims of water, and fed with low diet. Under this plan of treatment the symptoms began slowly to disappear and recovery was confidently hoped for, but on the 5th of this current month fever set in violently, keeping the patient awake all night and destroying his peace of mind. On the 6th a painful swelling made its appearance above the ankle-joint (left), which gradually increased and formed into an abscess, which being mature on the morning of the 7th was opened, and caused the matter to let out to the great relief of the patient. Since then all the symptoms began to disappear on
