CONTRIBUTIONS TO PRACTICAL MEDICINE AND SURGERY

FredericH. Morris
1864 The Lancet  
179 caused by the extraction of two teeth. One drop of croton oil to be taken at bedime. 3rd.-Had two fits, but much less violent, and only lasting about ten minutes; one occurred at twe and one at six P.M. Pulse 80, firmer, and regular ; respiration 20, normal. 4th.-Sat up for the first time. No fit; jaw still firmly closed. Appetite good, and she longs to be able again to take solid food. 5th.-Went out for a short walk. Bowels constipated. She is weak, but otherwise convalescent. To repeat
more » ... doss of croton oil. 7th.-Jaw still spasmodically closed; face swollen. To continue her wine. 12th.-Perfectly convalescent, but still quite unable to opn her mouth. uo return of fits since the 3rd of July. Galvanism again applied to the muscles of the jaw; no ill effects. 14th.-The galvanism repeated for ten minutes. 15th.-A more powerful current was applied to-day for a quarter of an hour, when she went off into an hysterical fi"" which lasted about five minutes. This time I observed the muscles of the jaw slightly quiver whilst galvanized. In the evening of the same day, when feeding herself with a spoon through the usual cavity, her mouth opened as suddenly as it had closed twenty-four days previously. I tested her urine several times whilst she was ill, and always found it loaded with lithates, its specific gravity varying from 1'033 to 1 030 ; it is now 1 025, acid, and has no deposit. The catamenia ap. peared at its usual time, and was of proper colour and quantity .during her illness. 20th.-Complains of aching of teeth, but is perfectly well in health. There is slight swelling of the face. 25th. -Quite well. This case has many points of interest :--1. In the origin of the diphtheria. She had been nursing where a whole family had been ill with, and two children had died from, malignant scarlatina, produced undoubtedly by the house being very imperfectly and badly drained, and by the overcrowding of its inmates—a, family of six occupying the same room. The same vitiated atmosphere that furnished the mate1'ies mo?-bi of the scarlatina in the children, was also the causa morbi of the diphtheria in the adult. This has a still further significance from the fact of the diph heritic patient having had scarlatina when a child. 2. As to the therapetical value of ice in diphtheria. My attention had been drawn to this remedy by a letter in THE LANCET of June 17th, and I should have recommended it in this case, but that, being Sunday, it was not easily obtainable; and as I supposed its value most depended on its coldness and consequent power to subdue inflammation by causing contrac tion of the capillaries, and thus lessening the circulation and diminishing the excessive heat, I imagined that a cold evapo. rating lotion constantly applied would have the same effect; and it certainly was attended with the best results. Ice to suck was also found very grateful to the patient, as well as beneficial. 3. The similarity of the fits to both epilepsy and tetanus occasioned me some doubt as to whether they were those attend. ing the former disease, or whether it was a case of idiopathic tetanus. There were many signs and symptoms to occasion me at first to imagine them merely the convulsions of epilepsy. She had been accustomed previous to her illness to epileptic fits, She had some warning of their approach, and then lost all con scionsness. The spasms of the muscles seemed more clonic thar the continuous tonic contractions of tetanus. During the fil she foamed at the mouth, but there was no protruding of thE tongue; the teeth were always firmly and immovably clinched. Trismus was complete for twenty-four days. The spasms were not continuous, the longest fit lasting three hours, the shortesi only ten minutes. Whilst the fit lasted she was perfectly un conscious, in this respect differing greatly from an attack o true tetanus, as also in being perfectly free from pain during thE intermission of the spasms, and from all contractions of the muscles, except those of the jaw, which was kep' uniformly closed, but produced no pain. Now in ordinary tetanus. whether traumatic or idiopathic, there is never entire fret"dorr from pain, or from the agonizing contractions, although therE may be intervals of comparative ease. But all (loul)t as to it: being a variety of tetanus ceased after my friend, Mr. Rouse, witnessed the tetanic fit (as I may now term it) on the 29ch o June, when the con of apisthotonos satisfactorily decided the true nature of the p sm ; for ti.is phenomenon may be and is, I think, correctly considered as pathogtionic of thi: most fearful disease. From that time I eved it to be thai intemittent tariety of idiopathic tetanus which Druitt mentions as being caused by marsh miasmata. The pulse was never above 90 after the convulsions set in, thus corresponding with Dr. Parry's statement, " that if the pulse was under 100 on the fourth day, the patient being an adult, a favourable result might be expected." From this, and from the fact of her greatest weakness being prior to the tetanic fits, as well as from other circumstances, my prognosis was always hopeful. Lastly. The means of cure. Trusting much to brandy and other nutritious aliment, so as to support life ; to gain time, so that the muscles might ultimately tire themselves of their morbid activity. To relieve any congestion that might exist of the brain, the spinal cord, and its membranes, by blisters locally, and croton oil internally. (My predecessor, Mr. Tomlinson, cured a case of idiopathic tetanus, which is recorded in THE LANCET, by continued blisters to the spine.) By the application of the galvanic battery to restore the proper action of the muscles; and regenerating their nervous power by the addition of the healthful stimulus of the galvanic current. It is worthy of notice, that the fits were less frequent after the very first application of galvanism. No opium or other seda-. tive was ever given, because all authors seem to agree that its value merely consists in alleviating the acute suffering; and that it has no power in lessening or controlling the morbid contractions. In this case the patient suffered no pain, being unconscious during the tetanic fits. Hence there was no indication for its use, and the excessive nervous exhaustion contra-indicated its administration.
doi:10.1016/s0140-6736(02)68396-5 fatcat:7jjxt3wquvbpdox725cdycmuby