The French trust mostly to opium in the treatment, and report favourable results from its use; though I suspect from what I have heard, that not a few cases of simple trismus were inadvertently classed by them under the more formidable disease of tetanus. I have been put in possession of the particulars of some cases which occurred in India, where amputation was had recourse to in tetanus. They all ended fatally without relief, though if performed early, before the peripheral irritation had time to set up much centric disturbance, this step would certainly appear to promise good results, in so far as the cause being removed, local applications to the spine would have a better chance of succeeding in allaying the excited Larrey amputated successfully in several cases, and speaks highly of it in those instances which are adapted for it, but after Toulouse it failed completely in our army, though tried extensively. was not common in the Kast.
During tinlirst IT it prevailed a good deal in a mild at Scutari, but it never became either general or e. It diil in>t appear to pass from bed to bed, but rose sporadically over the It frequently attacked the openings both of entrance and exit, but;lly seized on one only, showing apparently a pivdilrction for the wound of At times it showed only in part of a wound, and spread in one direction alone, li was never invariably, as far as I riety designated " ulcerous" by IMpech. and "phagedsena gangrenosa " by Bogpe. In many eases the best designation for it, as it appeared with us, would have been the old one of "putrid de<>n." The earliest symptom was pain in the. which sometimes preceded the ulcerative process by a couple of days.
The edges of the wound did nut swell Up, but remained thin as th undermined. pain generally continued during the process of dc;i"ii. It Ippaufed chieily in the lower extremities, and in wounds whose progress towards cure had been for some time stationary. Jt.-t-ldom burrowed far into the. but contined its acres to the surface and the circumference oi' the wound. I never saw any marked gastric disturbance attend it. It' it inds of those already labouring under to aggravate the; The abominable state in which the barrack hospital at iri was durii Ay oeeup;itioii. may well: Dr. Tnyl r thought in Ii, ii.i that gangrene more (mtwmlv appeared in the wounds occasioned by grape and canister.
I cannot say I observnl thi confirmed in the East, although it seems very probable it should be so. P THE CRIMEAN WAR. caused an outbreak of hospital gangrene among the br >ken-down men who lay so thickly around the doors of the offensive latrines; but I cannot say that I noticed any greater tendency to its appearance at these places than in any other portion of the hospital. The corridors presented, I think, the greatest number of cases. Whenever it appeared the patients were isolated, and sent into wards set apart for the treatment of the disease.* Nitric acid, applied locally, and the exhibition of the tincture of the muriate of iron internally, in half-drachm doses, three times daily, proved to be the most efficacious means of stopping it as it appeared in our hospitals.
The local nature of the complaint was universally recognized, and local measures relied on for its relief. The application of the escarotic, not only to the edges of the sore, but also to the healthy tissues, at a little distance round the margin, secured by far the best means of employing the remedy. A barrier of lymph appeared to be thus thrown up around, which prevented the spread of the peculiar inflammatory or destructive action in the skin and cellular tissue to which it was always confined. The attendant fever was uncertain in its development; sometimes it preceded, sometimes it accompanied, and sometimes it followed the local outbreak. Often there was little, if any constitutional disturbance, and occasion* How far this segregation into separate wards is a good plan, I am disposed to doubt.