16th?Passed
a
very restless
frequency of paroxysms; chloral hydrate. 17th.?Hud 12
no
severe
night, owing
stool; urine free.
to intensity and To continue the
paroxysms since last report; bowels
Continue chloral hydrate. \Sth.?Passed a very restless night. Tetanic spasms very severe, each paroxysm lasting about 5 minutes; bowels not opened ; no urine. Temperature 104 3? ; patient to be well protected from currents of air ; to have a purgative, and to continue the chloral hydrate. 19th.?Passed a tolerably good night; had 4 paroxysms, which were less severe than those on former occasions; had 4 stools ; urine free. Pulse quick and hard ; tongue moist; no appetite; temperature 99 2? ; ordered gr. x quinine to be taken at once, and to go on witli the chloral 20th.?Had 10 or 12 tetanic spasms during last 24 hours; temperature of body normal. Continue medicine, and to have small quantities of milk and sago frequently. 2\st.?Had 8 spasms during night ; bowels not opened for last 48 hours; to have a purgative, and to continue the
opened
once
during night.
medicine.
22nd ?Had 10 spasms during night; great rigidity of muscles of extremities, abdomen, neck, and jaws. Cannot open his mouth wide enough to admit an ordinary spoon. Continue chloral hydrate mixture. 23rd?Had several tetanic spasms during last 24 hours; temperature 102,4? ; pulse rapid ; bowels not opened. Continue mixture. 24 th.?Had 12 or 13 paroxysms since last report; rigidity of muscles the same.; temperature normal; pulse weak ; bowels not opened ; ordered some castor-oil- Continue mixture* 25th.?Eight paroxysms during night; passed six very offensive stools; can open his mouth a little better. Continue chloral hydrate mixture. 26th.?Passed a better night; had 12 paroxysms, mostly during the day ; rigidity muoli the same ; no stool or urine. To go on with the medicine. Spoon diet, and to be fed frequently in small quantities. 27th-?Had 6 spasms since last report ; these were less severe and sit longer intervals ; can open his mouth better ; bowels opened once. Continue mixture. 28th.?Complains of pain and tenderness in abdomen. spasms during night. 29th.?Pain in abdominal region increased
Eight
POOREE DISPENSARY. IDIOPATHIC TETANUS TREATED WITH CHLORAL PYDRATE: RECOVERY. By Surgeon H. W. Hill, AI.B. History.?Gonesli, Hindoo, 40 years of age, resident of the Punjaub. He is a pilgrim and came to Pooreo to attend the Car Festival," which fulls in July. Passing through the Mid* napore district (about the middle of last June), he had interAfter a few febrile mittent fever, to which ho is subject. attacks, the fever left him, and about a week after he noticed stiffness and pain in the neck and back. Says the days were Tery warm, but the nights damp and cool, and that he used to sleep in the open air on the road-side, and suffered considerably from chills during the night. The stiffness and pain increased, but he continued on his journey, reaching Pooree on the 13th July. The day following he was admitted into hospital as an in-patient. Symptoms on Admission.?Extreme rigidity of muscles of neck, jaws, and back; abdomen and extremities also slightly affected; can barely open his mouth; bowels costive; pulse hard and quick ; tongue white and dry. Complains of great thirst, but can with difficulty swallow. Temperature of body "
normal. Tetanic spasms follow
at intervals of 15 or 20 minutes ; well marked. Duration of paroxysms about 2 minutes. To have a castor-oil and turpentine enema at once, and then gr. xx chloral hydrate, three times a day. Diet consisting of milk and sago. 15th July.?Tliree stools after enema; slept a little during the night Rigidity about the same; paroxysms at some intervals. Continue chloral hydrate, t. d.
opisthotonos
; slept well. Tetanic spasms and fever less severe ; has a small bed-sore on the back. Ordered simple dressing to be applied to this ; capsicum and opium liniment to be rubbed over abdomen, and to continue the chloral. 30th.?Rigidity of muscles less; no pain in abdomen ; bed-sore clean ; had only slight tetanic spasms; bowels with spirit lotion, opened once. Ordered back to be rubbed and to continue the simple dressing and chloral.
31s?.?Had 4 very slight spasms during last 24 hours ; bed-sore healing. countenance less anxious and care-worn ; Continue same as last. ls? August.?Very slight paroxysms ; temperature of body 101'3? ; pulse weak ; appetite sharp, and is anxious for more food ; rigidity of muscles less. To have rice, milk, and sago. Medicines the same. 2nd.?No paroxysms since last report; rigidity of muscles very slight; can open his mouth wide enough to eat himself; bed-sore healed; bowels opened once. Continue same as last. Patient now steadily improved, and had no spasms till the night of the 7th, when ho had four slight ones, chiefly -affecting the muscles of the back. On the morning of this date ho complained of an aching pain in his lowor extremities, for which ho was ordered Linim. cnmph. c. Opio All theso days he continued taking gr. xx chloral hydrate three timers a day. The rigidity of muscles gradually became less marked, his appetite steadily improved, and the chloral hydrate was reduced to gr xx only once a day. On the 12th, he again had spasms, and was very restless and uneasy. The chloral hydrate to be taken three times a day as before. 13th.?Two slight paroxysms, but had a better night's rest; urine scanty and high colored. Sp gr. 1005, alkaline in re-action ; no albumen; bowels not opened for two days. To have a purgative and continue as last 14th.?Passed about a pint of clear urine this morning
-February 1, 1875.] Sp.
gr. 1024;
mixture.
no
spasms;
?
very
A MIRROR OF HOSPITAL PRACTICE. slight rigidity.
Continue
16^.?Two slight paroxysms during night; rigidity of muscles increased ; can scarcely open his mouth ; the weather lias become very damp. Ordered a warm bath, and to be immediately covered with blankets. To go oil with the chloral hydrate mixture. He improved, and had no spasms till the 22nd, when ho had several slight ones during the night. On the 26th, the chloral hydrate -was reduced to gr. XV. twice a day, and the day following this quantity was only to be taken once, as he had no recurrence of the spasms. On the 1 st September the chloral hydrate was omitted, and patient was put on a more generous diet. But, as lie complained of pain in his limbs, and was very uneasy on the 2nd, I ordered gr. x. of chloral hydrate at bed time. He now steadily improved, had no.more spasms, rigidity of muscles gradually " subsided, and he was discharged cured" on the 8th. Remarks.?This was a severe but typical case of idiopathic tetanus, caused, most probably, by exposure to the damp, chilly air of niglit, when the body was relaxed by the heat of the day, and the* constitution rendered "below par" by the recent febrile attack During the height of the disease the paroxysms ^ere very severe, and lasted for more than Ave minutes at a time. The patient was 56 days in hospital, during which time he took no less than 5 ounces 2 drachms and 55 grains of
chloral hydrate.
43
a
very restless
frequency of paroxysms; chloral hydrate. 17th.?Hud 12
no
severe
night, owing
stool; urine free.
to intensity and To continue the
paroxysms since last report; bowels
Continue chloral hydrate. \Sth.?Passed a very restless night. Tetanic spasms very severe, each paroxysm lasting about 5 minutes; bowels not opened ; no urine. Temperature 104 3? ; patient to be well protected from currents of air ; to have a purgative, and to continue the chloral hydrate. 19th.?Passed a tolerably good night; had 4 paroxysms, which were less severe than those on former occasions; had 4 stools ; urine free. Pulse quick and hard ; tongue moist; no appetite; temperature 99 2? ; ordered gr. x quinine to be taken at once, and to go on witli the chloral 20th.?Had 10 or 12 tetanic spasms during last 24 hours; temperature of body normal. Continue medicine, and to have small quantities of milk and sago frequently. 2\st.?Had 8 spasms during night ; bowels not opened for last 48 hours; to have a purgative, and to continue the
opened
once
during night.
medicine.
22nd ?Had 10 spasms during night; great rigidity of muscles of extremities, abdomen, neck, and jaws. Cannot open his mouth wide enough to admit an ordinary spoon. Continue chloral hydrate mixture. 23rd?Had several tetanic spasms during last 24 hours; temperature 102,4? ; pulse rapid ; bowels not opened. Continue mixture. 24 th.?Had 12 or 13 paroxysms since last report; rigidity of muscles the same.; temperature normal; pulse weak ; bowels not opened ; ordered some castor-oil- Continue mixture* 25th.?Eight paroxysms during night; passed six very offensive stools; can open his mouth a little better. Continue chloral hydrate mixture. 26th.?Passed a better night; had 12 paroxysms, mostly during the day ; rigidity muoli the same ; no stool or urine. To go on with the medicine. Spoon diet, and to be fed frequently in small quantities. 27th-?Had 6 spasms since last report ; these were less severe and sit longer intervals ; can open his mouth better ; bowels opened once. Continue mixture. 28th.?Complains of pain and tenderness in abdomen. spasms during night. 29th.?Pain in abdominal region increased
Eight
POOREE DISPENSARY. IDIOPATHIC TETANUS TREATED WITH CHLORAL PYDRATE: RECOVERY. By Surgeon H. W. Hill, AI.B. History.?Gonesli, Hindoo, 40 years of age, resident of the Punjaub. He is a pilgrim and came to Pooreo to attend the Car Festival," which fulls in July. Passing through the Mid* napore district (about the middle of last June), he had interAfter a few febrile mittent fever, to which ho is subject. attacks, the fever left him, and about a week after he noticed stiffness and pain in the neck and back. Says the days were Tery warm, but the nights damp and cool, and that he used to sleep in the open air on the road-side, and suffered considerably from chills during the night. The stiffness and pain increased, but he continued on his journey, reaching Pooree on the 13th July. The day following he was admitted into hospital as an in-patient. Symptoms on Admission.?Extreme rigidity of muscles of neck, jaws, and back; abdomen and extremities also slightly affected; can barely open his mouth; bowels costive; pulse hard and quick ; tongue white and dry. Complains of great thirst, but can with difficulty swallow. Temperature of body "
normal. Tetanic spasms follow
at intervals of 15 or 20 minutes ; well marked. Duration of paroxysms about 2 minutes. To have a castor-oil and turpentine enema at once, and then gr. xx chloral hydrate, three times a day. Diet consisting of milk and sago. 15th July.?Tliree stools after enema; slept a little during the night Rigidity about the same; paroxysms at some intervals. Continue chloral hydrate, t. d.
opisthotonos
; slept well. Tetanic spasms and fever less severe ; has a small bed-sore on the back. Ordered simple dressing to be applied to this ; capsicum and opium liniment to be rubbed over abdomen, and to continue the chloral. 30th.?Rigidity of muscles less; no pain in abdomen ; bed-sore clean ; had only slight tetanic spasms; bowels with spirit lotion, opened once. Ordered back to be rubbed and to continue the simple dressing and chloral.
31s?.?Had 4 very slight spasms during last 24 hours ; bed-sore healing. countenance less anxious and care-worn ; Continue same as last. ls? August.?Very slight paroxysms ; temperature of body 101'3? ; pulse weak ; appetite sharp, and is anxious for more food ; rigidity of muscles less. To have rice, milk, and sago. Medicines the same. 2nd.?No paroxysms since last report; rigidity of muscles very slight; can open his mouth wide enough to eat himself; bed-sore healed; bowels opened once. Continue same as last. Patient now steadily improved, and had no spasms till the night of the 7th, when ho had four slight ones, chiefly -affecting the muscles of the back. On the morning of this date ho complained of an aching pain in his lowor extremities, for which ho was ordered Linim. cnmph. c. Opio All theso days he continued taking gr. xx chloral hydrate three timers a day. The rigidity of muscles gradually became less marked, his appetite steadily improved, and the chloral hydrate was reduced to gr xx only once a day. On the 12th, he again had spasms, and was very restless and uneasy. The chloral hydrate to be taken three times a day as before. 13th.?Two slight paroxysms, but had a better night's rest; urine scanty and high colored. Sp gr. 1005, alkaline in re-action ; no albumen; bowels not opened for two days. To have a purgative and continue as last 14th.?Passed about a pint of clear urine this morning
-February 1, 1875.] Sp.
gr. 1024;
mixture.
no
spasms;
?
very
A MIRROR OF HOSPITAL PRACTICE. slight rigidity.
Continue
16^.?Two slight paroxysms during night; rigidity of muscles increased ; can scarcely open his mouth ; the weather lias become very damp. Ordered a warm bath, and to be immediately covered with blankets. To go oil with the chloral hydrate mixture. He improved, and had no spasms till the 22nd, when ho had several slight ones during the night. On the 26th, the chloral hydrate -was reduced to gr. XV. twice a day, and the day following this quantity was only to be taken once, as he had no recurrence of the spasms. On the 1 st September the chloral hydrate was omitted, and patient was put on a more generous diet. But, as lie complained of pain in his limbs, and was very uneasy on the 2nd, I ordered gr. x. of chloral hydrate at bed time. He now steadily improved, had no.more spasms, rigidity of muscles gradually " subsided, and he was discharged cured" on the 8th. Remarks.?This was a severe but typical case of idiopathic tetanus, caused, most probably, by exposure to the damp, chilly air of niglit, when the body was relaxed by the heat of the day, and the* constitution rendered "below par" by the recent febrile attack During the height of the disease the paroxysms ^ere very severe, and lasted for more than Ave minutes at a time. The patient was 56 days in hospital, during which time he took no less than 5 ounces 2 drachms and 55 grains of
chloral hydrate.
43
