1864 The Lancet  
farm-labourer, received a contusion of the shoulder in conse-z , quence of being jammed against a gate-post. On the 15th he ' , was sent to the hospital in a tetanic condition ; there was no ' , external wound or evidence of injury to the bone. Trismus was severe, and the least effort to open his mouth was accomi panied by violent spasms in the neck, which soon extended to the back and legs; indeed the whole of his muscular system became so affected that it was at times difficult to keep him on
more » ... the bed. Such were his sufferings that his near relatives only desired the one speedy termination to his misery. This state of things lasted for nearly three weeks, at the expiration of which time the severity of the symptoms began to subside, and he gradually advanced towards convalescence, which was slow. He left the hospital on July 3rd quite well. The treatment consisted of half a grain of acetate of morphia every night; castor oil and spirits of turpentine, half an ounce of each every morning, which acted freely, bringing away a quantity of vitiated offensive matter. The effort to swallow produced such violent spasms that we were often unable to get down the amount of nourishment required ; but the directions were to give as much strong beef-tea, milk, and port-wine as he could take, and we sometimes succeeded in getting down nearly half a pint of each in the twenty four hours, of course taken in very small quantities. Noah C-, aged forty-five, in good health, and a prudently living man, was admitted on the 21st of March, 1862, having that day had his wrist and hand crushed when attending to some machinery. I removed the arm below the elbow, and the case progressed most favourably for ten days. On the 31st he had a rigor, which was followed by stiffness in the jaw and neck, and was attributed to cold. On April 1st I strongly suspected what was impending, and on the 2nd we had wellmarked evidence of tetanus. The case was a severe one, and for three weeks he suffered as much as I had ever witnessed on like occasions. The spasms were excessively severe. Opisthotonos existed to such an extent that he often only touched the bed with his head and heels. From the inordinate action of the masseter and temporal muscles, as well as those of degluti-I tion, it was impossible to administer nourishment-which consisted of strong beef-tea, milk, and port wine-except in small quantities ; of the latter he sometimes took a pint in the twenty-four hours. The general opinion was that he must die, though I was encouraged by the successful issue of the former case to hope otherwise ; nor was I disappointed. On or about the 20th of April the case showed signs of amendment, which gradually though slowly progressed towards convalescence, and he left the hospital well on the 20th of May. The treatment carried out was the same as in the case of the boy S-, with the addition of the inhalation of chloroform, which afforded relief only during the first two days; and that of a blister to ' ' the spine, which decidedly increased the severity of the spasms and his misery. The only medicine given was a grain of acetate of morphia every night, and half an ounce each of castor oil and spirit of turpentine every morning, which was steadily persevered with, and brought away, as in the former case, a quantity of vitiated secretions. It will be evident to the reader that the tendency of the report of these cases, and my object in giving publicity to them, is to condemn the administration of powerful medicines, or resorting to active measures in the treatment of acute tetanus. We have here evidence in two instances of the subsidence of severe morbid irritation, the physical powers not having been crippled by depressing remedies. Hitcbin, Sept. 1864. ON the 12th of February last, Alex. C--, aged sixteen years, of apparently good health, was placed under my care. The following history of the case I learnt from him :-Three weeks previously he was seized with great pain in the right eye and around the orbit, lachrymation, and dimness of vision. At the expiration of a week from the attack the sight was quite gone. He was under no treatment. On examining the eye, I found the cornea surrounded with a zone of vessels, dull, and prominent from the amount of turbid aqueous humour. The iris was dilated, immovable, and the free margin projecting backwards. He still com4 plained of great pain, and could only discern light from dark4 ness. On the 13th of February I performed Mr. Hancock's operation for division of the ciliary muscle. Feb. 15th.-Pain very much relieved, and the cornea and aqueous humour clearer. He was able to distinguish a large key, and also a book. 16th.-The iris commences to act. 20th.-The sight steadily improving. To take an iodide of potassium mixture, which was continued for about three weeks. At the expiration of that time the improvement was not so marked as one could wish. The eye was examined on the 4th of May (nearly three months after the operation), and the result was very satisfactory and gratifying. The cornea was nearly clear and much less prominent, the aqueous humour brighter, the iris acted well, and the pain had entirely gone. He could discern any object readily, and read the print of a large Bible.
doi:10.1016/s0140-6736(02)68655-6 fatcat:jc7sd3rkxncrrav47r4g6zl44a