General Retrospect

1848 BMJ (Clinical Research Edition)  
reports the case of a man who had a inger jammed in machinery. On the fifth day he received a very urgent message, stating that he had had no sleep since he saw him, and that he had been dying * nce two In the morning, and he was requested to meet Dr. Bell Fletcher. At eight oclock he visited the patient with Dr. Fletcher. They found him per;f eCtly stiff with tetanic spasm. He appeared conscious. but had lost all power of articulation and deglutition, The whole surface of his body was bathed
more » ... s body was bathed in perspiration; every muscle seemed implicated in the spastic action; indeed, be had all the ordinary symptoms of tra,mtat4c tetanus, and no hope was entertained of his recoverWig from this condition. They ordered a torpentine enema to be administered immediately, and the tincture of cannabis sativa to be given in doses of twenty minims every three hours; and thinking it a favourable case for the application of the chloroform, it was arranged that it sbould be administered on the next visit. At two p.m. Mr. Baker again saw him, and found him in the same state in which they left him in the morning. The attendants could not get him to swallow the medicine, and made ineffectual attempts to give a glyster. Under these circumstances he ad. spinistered the chloroform on a handkerchief, and in about three minutes the muscles began to relax. The thumb which had been firmly grasped by the fingers into the palm, became quite easily moved; for a short time he muttered incoherently, then answered two or three questions rationally,and finally sank into a sound sleep, with the muscular system relaxed and free from convulsions. Mr. Baker kept up the effect of the chloroform for three quarters of an hour, and left him asleep, having prescribed a blister to be applied to the back of the neck, and two grains of calomel every two hours, to get free action of the bowels. At nine p.m. he again visited him, and learned that an hour after he had left him the patient awoke, as if from sleep, with the free use of his limbs restored, and asking to be assisted to the night-chair, where he had a copious stool, and entered into rational conversation with those around him. From this time his general health gradually improved; but the finger continued much swollen. Finding, on the 3rd ultimo, that the pain had increased, with slight muscular convulsive twitches, and tlhinking that the finger might be the cause of irritation, and, oonsequently, being fearful of a return of the tetanic symptoms, Mr. Baker determined to remove the finger at once. Not having the chloroform with him, he amputated it without its use; and since its removal there has been no return of the convalsive symptoms, and the patient is doing well. The tetanus came on five days after the accident, .and the finger was amputated on the eleventh day after the original injury, and six days after the suc-t1l adminbtratlonof chloroform_-Lancet,June 3rd. TRELTMENT OF ASPHYXIA. Dr. Reid, of Liverpool, suggests, thaf in tresting the apparently asphyxiated, a certain proportion of chlorini or nitrous oxide should be used with the atmoipheric air employed in artificial respiration. Ile is lea to propose this on the principle that the chief object is, independent of restoring the circulation and temperature, that the dormant irritability should be subjected to an extraordinary stimulant. While the common atmospheric air, or even oxygen gas perfectly pure, has no action, the irritative action of this gas, (the chlorine,) so well known in the living subject, will, in a corre;. ponding manner, be more energetic in the lungs of the apparently drowned. In numerous experiments made on the healthy subject, and also on several different invalids, he has found that in the former, on an average of about 200 individuals, one cubic inch of chlorine, diffused through 200 cubic inches of air, (common air,) could be respired without exciting any irritation; bat, when the quantity of atmospheric air was reduced, the amount of chlorine remaining the same, more or less irritation wasinduced. Itisunnecessarytoiremarkon the different effects on invalids, as these varied very much, and it would be impossible to make nice applications of the sort in cases of asphyxia. One cubic inch of chlorine may be diffused through fifty cubic inches of air for this purpose, or even one cubic inch in twenty-five cubic inches of atmosphenic air. The respiratory movements once being excited, the amount of chlorine may gradually be reduced. Scarcely any bad effect will supervene which cannot be relieved by ammonia and hot water. The chlorine is readily obtained from the common chloride of lime.-Lancet, April 22nd. SURGERY. UMBILICAL HERNIA IN CHILDREN. Mr. Spong, in speaking of the treatment of this disease, says :-Well regulated, constant, and equable pressure, seems all-sufficient for the cure of this disease in infants, and the elastic belt, presently to be described, answers the purpose effectually. It consists of a piece of vulcanized caoutchouc, about six inches in length, and three inches and a half.in breadth, to either end of which ia attached a piece of fine white linen web, (a species of girthing, used.by saddlers, and manufactured .of about the same breadth,) with tapes appended, which are tied behind the back. The piece of vulcanized India-rubber should be of such a length, according to the size of the child, as will embrace rather less than one-third of the circumference of the abdomnen, the circle being dbmplettd by the pieces of linen web. Thij material is sufficiently stiff to prevent its creasing; its elasticity admits of the various movements of the child, its crying, coughing, &c'; and in whatever. position the boy is placed, it ever keeps up a deteTminate pressure. The patient soon become.aacciuaraed to its, se, and.it may be worn advantageously by. night as well as by day; moreover, it retins its posifto accurately. Thi substauce is utade of various degrees of tbiclk. nes; that which is about as thick as half-a-crowi.wi GENERAL RETROSPECT. ..332
doi:10.1136/bmj.s1-12.12.332 fatcat:jr7ahn55njgnjhztazdumhhgky