THE INDIAN MEDICAL GAZETTE.
68
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POOEEE DISPENSAEY.
John Meredith, M.D.
The notes of this case were kept for me by the native doctor in charge of the Pooree Government dispensary. Rughoonath, aged 35, Hindoo, field laborer, was brought into the dispensary on the 25th of December 1873, suffering from tetanus in a marked form. The history given of him by his friends was to the following effect: Some ten days before, (I could not feel certain about the precise date) he was using his dao, paring a bamboo, the instrument slipped and wounded him on his left leg, inner side, and A few days afterwards (how many it a little above the ankle. was not at all clear) he experienced pain and stiffness in the these increased during the few days he' muscles of his neck ; remained at his house, until his whole body became rigid to a
painful degree.
. _
At the time of his admission he had spasms about every ten minutes, and cculd swallow nothing but fluids, although able to open his mouth enough to admit an ordinary spoon. Pulse 90; temperature in armpit 105?. Bowels had been costive for several days, until the day before admission. At 8-30 a.m. given 20 grs. chloral hydrate. Slept for some hours, and had no spasms during sleep. 5 p.m., another dose of chloral, as he was becoming restless and the spasms were returning. A third dcse was given during the night. 26th December.?Slept a good deal during the night; had spasms only ;vhen awoke or roused ; passed urine freely ; bowels not opened for two days. Pulse 90 ; temperature 103o,2. To have 20 grs. of chloral hydrate three times a day, and as much milk, sago, &c., as he could take. He was put in a room by himself, attended by his own friends, and sheltered fiom all draughts and chills as much as possible. Had an aperient pill consisting of scam. gr. v. Est hyos. gr. v. Pil. hydrag. grs. ii, in the morning. No result following, given a saline mixture in the afternoon.
27th.?No marked change ; pulse 88 ; temperature 101*3?. Ho effect from the saline mixture, an enema of ol. ricini and turpentine administered. This failed to produce the desired effect also. He was very restless during this day, but he had no spasms except when awoke or disturbed. 28th.?Pulse 95 ; temperature 99?. No action of bowels;
ol. croton in. i on some sugar ; a few hours afterwards his bowels were freely moved. During the day he took a fair quantity of food. From this date to the 31st there was not much to note. His temperature rose to 102u once, and his pulse to 100 and fell on the last date to 98? and 80 respectively, and his respirations were occasionally 28 in the minute. He voided his urine freely. 1st January 1874.?Had no spasms during the night; slept well. Temperature 98?, and it never rose above this from this time He was evidently excited this on ; respiration 29 ; pulse 94. morning, and wanted to go away to his village; his friends wished to take him. I had not succeeded in getting his urine for examination until to-day. "When examined it presented a dark yellow color, e.g. 1022, chlorides almost entirely absent; no albumen. The yellow colour remained on boiling, but on the addition of nitric acid fort, it was dispelled, and the fluid became pale straw color, accompanied with the escape of a great deal of gaseous matter. 2nd.?Pulse 92; rather weak. The muscles of his legs softer; but those of the abdomen still very tense ; could open his mouth sufficiently to take solid
given
food. 3rd, 4th and 5th.?Gradual decrease of the rigidity of the muscles of the lower liin'bs was noticeable. On the 3rd he had only one
dose of chloral, that night he was very restless ; on the 4th his He medicine was given him : 25 grains three times a day. had slight spasms now and again ; pulse high again ; on the 5th, 104?. 6th and 1th.?Improving. Urine was scanty during the last two or three days. On the 7th could bend his legs a little. 8th and 9th.?Bowels acted freely, and he passed urine sufficiently. Eigidity much decreased ; appetite good ; temperature natural; pulse 84. 10th.?Rigidity of the limbs increased to-day owing to his friends exposing him to a cold draught.
2, 1874.
11 th.?Tension worse again to-day owing to imprudent exposure, otherwise he is doing well. 12th to 18th ?Slow improvement perceptible ; some days he ?would expose himself to cold air, and immediately he would suffer for it. The same treatment was steadily adhered to from the commencement. 19
68
???
POOEEE DISPENSAEY.
John Meredith, M.D.
The notes of this case were kept for me by the native doctor in charge of the Pooree Government dispensary. Rughoonath, aged 35, Hindoo, field laborer, was brought into the dispensary on the 25th of December 1873, suffering from tetanus in a marked form. The history given of him by his friends was to the following effect: Some ten days before, (I could not feel certain about the precise date) he was using his dao, paring a bamboo, the instrument slipped and wounded him on his left leg, inner side, and A few days afterwards (how many it a little above the ankle. was not at all clear) he experienced pain and stiffness in the these increased during the few days he' muscles of his neck ; remained at his house, until his whole body became rigid to a
painful degree.
. _
At the time of his admission he had spasms about every ten minutes, and cculd swallow nothing but fluids, although able to open his mouth enough to admit an ordinary spoon. Pulse 90; temperature in armpit 105?. Bowels had been costive for several days, until the day before admission. At 8-30 a.m. given 20 grs. chloral hydrate. Slept for some hours, and had no spasms during sleep. 5 p.m., another dose of chloral, as he was becoming restless and the spasms were returning. A third dcse was given during the night. 26th December.?Slept a good deal during the night; had spasms only ;vhen awoke or roused ; passed urine freely ; bowels not opened for two days. Pulse 90 ; temperature 103o,2. To have 20 grs. of chloral hydrate three times a day, and as much milk, sago, &c., as he could take. He was put in a room by himself, attended by his own friends, and sheltered fiom all draughts and chills as much as possible. Had an aperient pill consisting of scam. gr. v. Est hyos. gr. v. Pil. hydrag. grs. ii, in the morning. No result following, given a saline mixture in the afternoon.
27th.?No marked change ; pulse 88 ; temperature 101*3?. Ho effect from the saline mixture, an enema of ol. ricini and turpentine administered. This failed to produce the desired effect also. He was very restless during this day, but he had no spasms except when awoke or disturbed. 28th.?Pulse 95 ; temperature 99?. No action of bowels;
ol. croton in. i on some sugar ; a few hours afterwards his bowels were freely moved. During the day he took a fair quantity of food. From this date to the 31st there was not much to note. His temperature rose to 102u once, and his pulse to 100 and fell on the last date to 98? and 80 respectively, and his respirations were occasionally 28 in the minute. He voided his urine freely. 1st January 1874.?Had no spasms during the night; slept well. Temperature 98?, and it never rose above this from this time He was evidently excited this on ; respiration 29 ; pulse 94. morning, and wanted to go away to his village; his friends wished to take him. I had not succeeded in getting his urine for examination until to-day. "When examined it presented a dark yellow color, e.g. 1022, chlorides almost entirely absent; no albumen. The yellow colour remained on boiling, but on the addition of nitric acid fort, it was dispelled, and the fluid became pale straw color, accompanied with the escape of a great deal of gaseous matter. 2nd.?Pulse 92; rather weak. The muscles of his legs softer; but those of the abdomen still very tense ; could open his mouth sufficiently to take solid
given
food. 3rd, 4th and 5th.?Gradual decrease of the rigidity of the muscles of the lower liin'bs was noticeable. On the 3rd he had only one
dose of chloral, that night he was very restless ; on the 4th his He medicine was given him : 25 grains three times a day. had slight spasms now and again ; pulse high again ; on the 5th, 104?. 6th and 1th.?Improving. Urine was scanty during the last two or three days. On the 7th could bend his legs a little. 8th and 9th.?Bowels acted freely, and he passed urine sufficiently. Eigidity much decreased ; appetite good ; temperature natural; pulse 84. 10th.?Rigidity of the limbs increased to-day owing to his friends exposing him to a cold draught.
2, 1874.
11 th.?Tension worse again to-day owing to imprudent exposure, otherwise he is doing well. 12th to 18th ?Slow improvement perceptible ; some days he ?would expose himself to cold air, and immediately he would suffer for it. The same treatment was steadily adhered to from the commencement. 19
