This, with enemas, nourishing food, and local emollient applications, comprehended all the treatment. The symptoms were not abated, except for short intervals, and then only in proportion as sleep was procured. His skin was always covered with an odorous perspiration. The abdomen got distended and hard. The muscles of the back were markedly hard and contracted, particularly on the left side. The left leg was stretched out spasmodically, every muscle defined. The right limb was drawn up? and he lay across the bed. The wound was sloughy, and shreds of fascia escaped with the discharge. The urine became scanty and highcoloured, and required to be drawn off by the catheter. Eventually he suffered much pain in the left groin and calf of the leg, as well as at the ensiform cartilage.
When trying to raise himself on his elbow on the fifth day of the attack, and seventeenth after admission, he was violently convulsed, so that he was bent greatly backwards; he put his hand to his throat as if choking, and fell back dead. The wound was found to be lined with an ashy slough. TETANUS. The bone was not injured. The fascia lata was much torn, and was pierced and ulcerated at a spot on the rior and external aspect of the limb, some little nee from the wound. The ball had evidently peneto this point. No nerve fibres could be detected the wound. The parts in the neighbourhood were sound. The brain and internal organs were healthy, lungs were only slightly congested, and viscid mucus was present in the larger tubes.
The spinal canal contained a good deal of fluid blood. The cord and its membranes were congested. In the lower cervical and upper dorsal region the substance of the cord varicose contracted and expanded into a series of knots. There was no other pathological appearance. On looking at these two cases in connection, the curious parallelism must strike one. The very distinct manner, too, in which so many of the peculiar symptoms of this deadly disease were developed, particularly in the first case, was interesting. Whether opium, which appeared to act so beneficially, had it, been pushed further, so as to produce a more decided impression, would have done good, is a question. I l>clie\v it would have affected tinresult but little.
The similarity between the wounds in these two cases, the aon-difloorery of the balls for some days, the sy: 1 le season of the year, and the state.cord in the last ca.intcivstinu:. That t ure we had at that period had much to do with the produrtion ne QAM of tetanus. edin;; an injury of the foot, which recovered, chl i was repeatedly a for prolon-rd pen and anodynes applied to the spine. The particulars of this case are, I understand, to be published by the surgeon in charge, Dr. Ward of the 17th regiment. As to treatment we are yet unfortunately in the dark.
Romberg sums up his review of the question thus: " The results of treatment amount to this, that wherever tetanus puts on the acute form, no curative proceeding will avail; whilst in the milder and more tardy form, the most various remedies have been followed by a cure." Larrey trusted most to opium and camphor, with section of the nerve in cases adapted for it. On reading the many accounts which have been given of cases of this disease, opium and chloroform appear decidedly to have the greatest evidence in their favour. The unpublished records of the Indian campaigns, illustrate to a great extent the remarkable effect which unextracted balls seem to exercise on the development of this fatal affection, more especially when they lay under strong fasciae, as in my cases.
In India, as well as in the continental campaigns, amputation at the shoulder appears to be one of the operations most frequently followed by tetanus. Sudden vicissitudes of temperature have been always looked upon as most powerful causes of tetanus, especially the change from a hot day to a cold and damp night, which is so common in the tropics. So it was after the battles of Ferozepore and Chillianwallah, when the wounded lay exposed to very cold nights succeeding days of hard work under a burning sun. Larrey notices the same circumstances as having predisposed to the disease in Egypt, and in the German campaign of 1809. After Bautzen the exposure to a very cold night produced TI:T\N; a hundred. id after tinbattle of Dresden. when the wounded were placed in like circumstances, lost a very large number from tetanus.