One followed a slight wound of the face; another, a wound of the hand; another, a wound of the ear. Three were cases of flesh wounds. One was an amputation of the foot; one, an amputation of the arm; one, a wound of the foot; and one was from tln-ir presenting sonic points of interest, of which not tlu.me similarity to one another. Hughes, a private of the 44th regiment, was admitted int> the general hospital <>n the Mh of June. In the;lt on the Kedan, a hall had entered an inch below nterior superior spinous process of the riglit ilium, and passing downwards and outwards, lodged deeply ng the muscles of the thigh.
After a most earei'ul and pr -longed examination, its position could not be ascer1. and it was left, in the hope that in a day or two it.t become defined, or that it might ]ierha])s remain altogether without doing harm. There was no fracture, and no pain. The case was treated as a flesh wound. On the thirteenth day, the patient for the first time complained of pain behind the great troelianter of the right. and the presence there of deep fluctuation caused me to make an incision. A considerable accumulation of pus was found, and in the sack of this collection I d tin- ball much flattened. I freely enlarged the wound, so that all ivt-nti<>n of matter was prevented. t day some cloth was discharged from this opening.,th day his manner was changed.
He was irritable, and complained of his wound. Pus conbj a fish-bone Pi i.inmtimictl two were.-imputations of the thigh; one, A WOUixl l.y round shot of tlul.;u k; another, a similar wound leg; another, av hand; and tin- sixth u as a Lin. r of the forehead. Several of the.se r these cases, it would not appear that wounds of <it h.r th. f,.,,t. lower extremity, show a greater tendency to cause tetanus than others. tinned to flow freely, and his general health was unimpaired, lie said that he had caught cold, and " that it had taken him in the jaws," which were a little stiff.
His bowels being costive, I ordered him a purge, and an embrocation for his jaws. I had not at this time any suspicion of the impending evil. Next day I found that his bowels had been fully moved, and that most offensive dark-coloured stools had resulted. The trismus was now very marked. The masseters were hard and contracted, like clamps of iron. I examined the wound, and further enlarged it. A large emollient cataplasm was applied, and a drop of croton oil given internally. His bowels were freed of much more of the same fetid dejection which he had voided formerly. In the afternoon, when rising to go to stool (which he insisted on doing), he had a violent spasm over the right side of the body, not accompanied with any pain.
From this time the spasmodic contractions set in, recurring at certain intervals, leaving him at times for half a day, but always returning till his death. These spasms were nearly confined to the wounded side, arid affected the muscles of the thigh most. I began the use of the acetate of morphia in gr. ij. doses, and afterwards diminished it to one grain administered every hour till he slept. This he did in snatches during the succeeding days, waking up startled if any one walked near his bed. Whenever he slept for an hour or two, his symptoms were markedly alleviated. When he slept, the opium was intermitted for some hours, and then resumed. Only on the first day did he exhibit the slightest symptoms of narcotism, and so much relief did he experience from the use of the drug, that he earnestly asked for it whenever he was a itliout sleep.
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