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A CASE OF TETANUS.
739
drowning by jumping into deep water. weak and illogical argument I have seldom seen put forward. In the latter instance, when rescuer and rescued have both landed, there usually is an end of the case, and the drowning person does not require to be rescued every few hours, as was done in this case by Mr. Moore repeatedly sucking the tube. And again, when the heroic act of the swimmer is over, there is no fear of deadly inoculation working in the system, disease developing in a few days, and death within a week. This case is instructive as to the period of incubation in diphtheria ; the tube was sucked for the first time at 11 P.M. on April 1st, and the first symptoms of the disease showed themselves at 6 A.M. on 3rd, at which time he expressed his opinion to his wife that he had contracted the disease, as he felt unwell, and his throat was sore; so that the period of incubation by inoculation through the mucous membrane may be taken at thirty hours, but the diphtheritic deposit did not manifest itself until twenty-four hours later. Uxbridge. creature from
A
more
and well nourished, was admitted to St. Luke’s Hospital for Chinese under my care on July 26th, 1889. For seventeen years she had had a slowly growing, somewhat pear-shaped tumour on the posterior surface of the right thigh, just below the gluteal fold. The tumour had attained the size of a melon, was freely movable on the fascia, and was quite indolent. Its apex was ulcerated, the result of native treatment by plasters, but this ulceration already dated
back to
nearly a year. The growth and surrounding parts extremely illthy. As a preliminary to removal, frequent washing was ordered, the ulcerated surface was sprinkled with iodoform, and the tumour was enveloped in freshly carded oakum. This was the only treatment that the patient received. The weather was extremely hot, the the thermometer in the shade marking 100’F. on July 27th and 28th. The patient ate well and slept well, and in every respect, except as regarded the local trouble, was in excellent health. On the evening of the 28th she sat for a couple of hours outside the ward door on a staircase through which a strong current of comparatively cold air Next morning (29th) she complained of pain was blowing. and stiffness in the muscles of the neck and inability to depress the lower jaw. The incisors could not be separated to a greater distance than three-quarters of an inch. During the day tetanic spasms in the trunk and limbs occasionally occurred. These became more frequent the night. was immovable. MEDICAL, SURGICAL, OBSTETRICAL, AND On the morning of the 30th the lower jawduring Temperature obtained in axilla 105.8°, and no doubt higher. THERAPEUTICAL. Spasms became more frequent, but were never violent. Temperature rose to 107°, delirium lasted for about an hour, A CASE OF DYSENTERY TREATED BY INJEC- giving place to unconsciousness, death following in an hour and a half, thirty-six hours after the onset of the symptoms. TIONS OF SULPHATE OF COPPER. were
_______________
Clinical Notes:
BY W.
EASBY, M.D.
Shanghai.
______________
A CASE OF
narrated in THE LANCET of Aug. 31st by Mr. DOUBLE POLYDACTYLISM, DOUBLE HARELIP, Hepburn reminds me of a case where injections of sulphate COMPLETE CLEFT PALATE, AND DOUBLE of copper were most successful. The patient, J. 0, TALIPES VARUS. aged fifty, was a thin, spare man. He lived in the Cam BY F. MARSH, F.R.C.S., bridgeshire Fens, and in his young days had suffered from SURGEON TO THE QUEEN’S HOSPITAL, BIRMINGHAM, ETC. ague. The water-supply to his house was very bad ; the usual drinking water was rain water kept in a wooden tul, THE following case presents features of teratological and when this ran short that from the dykes was used. I first saw him on Dec. 31st, 1876 ; he had all the symptoms interest. A male infant, three days old, was brought as an of a smart attack of dysentery ; these continued for a week, out-patient to the Children’s Hospital, Birmingham, on when he was much better. On Jan. 14th, 1877, he had a 1889. On each hand there was a supplementary 9th, Sept. relapse, but improved by the 20th. On the 21st I heard he digit attached by a narrow pedicle to the skin over the was worse, and was passing a lot of blood, and had much tenesmus. I at once prepared an injection of sulphate of ulnar side of the head of the fifth metacarpal bone. Each copper, 10 gr. ; tincture of opium, 1 dr. ; and 4 oz. of water. digit, including the nail, was perfect, and almost equal in On reaching the house I found him lying in a small pool of size to the adjoining little finger. Both hard and soft blood. He informed me this had been going on all night, palates were fissured, the cleft in front being distinctly to and the tenesmus was unbearable, bringing away blood and the left of the mesial line. The double harelip and the I well oiled a large long gum-elastic catheter, and talipes were severe examples of their respective deformities. mucus. with a finger in the rectum passed it as far into the bowel In other respects the infant was normal and fairly nourished. as it would go, which was at least fifteen inches ; through It was, however, very feeble, and died from malnutrition on this the copper solution was injected from a small brass Sept. 16th. The mother had previously given birth to nine syringe ; it caused no pain ; and in the evening the tenesmus children, all of them healthy and in no way deformed. was relieved, and very little blood had passed. On the 22nd Careful inquiry failed to elicit any history of polydactylism he was decidedly better, but more blood in the stools than in any branch of the family. No " maternal impressions" I liked, so the injection was repeated, and again on the had been received, the deformities being both unexpected by, 23rd ; and from this date he recovered My treat. and inexplicable to, the mother. ment prior to the copper injection was bismuth, gallic acid, The case is an unusual one, if not a unique one, coma full dose of powdered ipecacuanha ; but nothing gave such bining as it does deformities the result of three different rapid and permanent relief as the copper and opium. The causes: (1) the extra digits due to developmental excess; diet was purely milk. I have not had such a bad case as (2) the harelip and cleft palate due to developmental this in an adult since, but in children several ; and here arrest; (3) the talipes varus due to foetal malposition or the same treatment proved successful. mechanical pressure in utero. Peterborough. Birmingham. THE
case
rapidly.
___
A CASE OF TETANUS. BY R. A.
JAMIESON, M.A., M.D., M.R.C.P.,
CONSULTING SURGEON TO THE IMPERIAL MARITIME CUSTOMS IN CHINA.
IN the
_______
GLYCERINE OF BORAX IN THE DIARRHŒA OF INFANTS. BY E. MANSEL SYMPSON, M.A., M.B. CANTAB.
case here briefly reported there was a singular lack IF we regard infantile diarrhoea, as due to the excessive proportion between the phenomena induced, rapidly fermentation of food in the intestinal canal causing irritaculminating in death, and their exciting cause. The patient tion and a catarrhal condition of the intestinal mucous had had no contact with horses directly or indirectly, and membrane, it seems reasonable to look for a remedy to act no case of tetanus had ever been treated in the ward where both on the cause and effect. Glycerine itself is an antishe lay. no the congestion and of and relieves mean order, septic A Chinese woman, aged fifty-one, field labourer, ruddy pain of inflamed piles, chiefly mucous surfaces, while every
of
drowning by jumping into deep water. weak and illogical argument I have seldom seen put forward. In the latter instance, when rescuer and rescued have both landed, there usually is an end of the case, and the drowning person does not require to be rescued every few hours, as was done in this case by Mr. Moore repeatedly sucking the tube. And again, when the heroic act of the swimmer is over, there is no fear of deadly inoculation working in the system, disease developing in a few days, and death within a week. This case is instructive as to the period of incubation in diphtheria ; the tube was sucked for the first time at 11 P.M. on April 1st, and the first symptoms of the disease showed themselves at 6 A.M. on 3rd, at which time he expressed his opinion to his wife that he had contracted the disease, as he felt unwell, and his throat was sore; so that the period of incubation by inoculation through the mucous membrane may be taken at thirty hours, but the diphtheritic deposit did not manifest itself until twenty-four hours later. Uxbridge. creature from
A
more
and well nourished, was admitted to St. Luke’s Hospital for Chinese under my care on July 26th, 1889. For seventeen years she had had a slowly growing, somewhat pear-shaped tumour on the posterior surface of the right thigh, just below the gluteal fold. The tumour had attained the size of a melon, was freely movable on the fascia, and was quite indolent. Its apex was ulcerated, the result of native treatment by plasters, but this ulceration already dated
back to
nearly a year. The growth and surrounding parts extremely illthy. As a preliminary to removal, frequent washing was ordered, the ulcerated surface was sprinkled with iodoform, and the tumour was enveloped in freshly carded oakum. This was the only treatment that the patient received. The weather was extremely hot, the the thermometer in the shade marking 100’F. on July 27th and 28th. The patient ate well and slept well, and in every respect, except as regarded the local trouble, was in excellent health. On the evening of the 28th she sat for a couple of hours outside the ward door on a staircase through which a strong current of comparatively cold air Next morning (29th) she complained of pain was blowing. and stiffness in the muscles of the neck and inability to depress the lower jaw. The incisors could not be separated to a greater distance than three-quarters of an inch. During the day tetanic spasms in the trunk and limbs occasionally occurred. These became more frequent the night. was immovable. MEDICAL, SURGICAL, OBSTETRICAL, AND On the morning of the 30th the lower jawduring Temperature obtained in axilla 105.8°, and no doubt higher. THERAPEUTICAL. Spasms became more frequent, but were never violent. Temperature rose to 107°, delirium lasted for about an hour, A CASE OF DYSENTERY TREATED BY INJEC- giving place to unconsciousness, death following in an hour and a half, thirty-six hours after the onset of the symptoms. TIONS OF SULPHATE OF COPPER. were
_______________
Clinical Notes:
BY W.
EASBY, M.D.
Shanghai.
______________
A CASE OF
narrated in THE LANCET of Aug. 31st by Mr. DOUBLE POLYDACTYLISM, DOUBLE HARELIP, Hepburn reminds me of a case where injections of sulphate COMPLETE CLEFT PALATE, AND DOUBLE of copper were most successful. The patient, J. 0, TALIPES VARUS. aged fifty, was a thin, spare man. He lived in the Cam BY F. MARSH, F.R.C.S., bridgeshire Fens, and in his young days had suffered from SURGEON TO THE QUEEN’S HOSPITAL, BIRMINGHAM, ETC. ague. The water-supply to his house was very bad ; the usual drinking water was rain water kept in a wooden tul, THE following case presents features of teratological and when this ran short that from the dykes was used. I first saw him on Dec. 31st, 1876 ; he had all the symptoms interest. A male infant, three days old, was brought as an of a smart attack of dysentery ; these continued for a week, out-patient to the Children’s Hospital, Birmingham, on when he was much better. On Jan. 14th, 1877, he had a 1889. On each hand there was a supplementary 9th, Sept. relapse, but improved by the 20th. On the 21st I heard he digit attached by a narrow pedicle to the skin over the was worse, and was passing a lot of blood, and had much tenesmus. I at once prepared an injection of sulphate of ulnar side of the head of the fifth metacarpal bone. Each copper, 10 gr. ; tincture of opium, 1 dr. ; and 4 oz. of water. digit, including the nail, was perfect, and almost equal in On reaching the house I found him lying in a small pool of size to the adjoining little finger. Both hard and soft blood. He informed me this had been going on all night, palates were fissured, the cleft in front being distinctly to and the tenesmus was unbearable, bringing away blood and the left of the mesial line. The double harelip and the I well oiled a large long gum-elastic catheter, and talipes were severe examples of their respective deformities. mucus. with a finger in the rectum passed it as far into the bowel In other respects the infant was normal and fairly nourished. as it would go, which was at least fifteen inches ; through It was, however, very feeble, and died from malnutrition on this the copper solution was injected from a small brass Sept. 16th. The mother had previously given birth to nine syringe ; it caused no pain ; and in the evening the tenesmus children, all of them healthy and in no way deformed. was relieved, and very little blood had passed. On the 22nd Careful inquiry failed to elicit any history of polydactylism he was decidedly better, but more blood in the stools than in any branch of the family. No " maternal impressions" I liked, so the injection was repeated, and again on the had been received, the deformities being both unexpected by, 23rd ; and from this date he recovered My treat. and inexplicable to, the mother. ment prior to the copper injection was bismuth, gallic acid, The case is an unusual one, if not a unique one, coma full dose of powdered ipecacuanha ; but nothing gave such bining as it does deformities the result of three different rapid and permanent relief as the copper and opium. The causes: (1) the extra digits due to developmental excess; diet was purely milk. I have not had such a bad case as (2) the harelip and cleft palate due to developmental this in an adult since, but in children several ; and here arrest; (3) the talipes varus due to foetal malposition or the same treatment proved successful. mechanical pressure in utero. Peterborough. Birmingham. THE
case
rapidly.
___
A CASE OF TETANUS. BY R. A.
JAMIESON, M.A., M.D., M.R.C.P.,
CONSULTING SURGEON TO THE IMPERIAL MARITIME CUSTOMS IN CHINA.
IN the
_______
GLYCERINE OF BORAX IN THE DIARRHŒA OF INFANTS. BY E. MANSEL SYMPSON, M.A., M.B. CANTAB.
case here briefly reported there was a singular lack IF we regard infantile diarrhoea, as due to the excessive proportion between the phenomena induced, rapidly fermentation of food in the intestinal canal causing irritaculminating in death, and their exciting cause. The patient tion and a catarrhal condition of the intestinal mucous had had no contact with horses directly or indirectly, and membrane, it seems reasonable to look for a remedy to act no case of tetanus had ever been treated in the ward where both on the cause and effect. Glycerine itself is an antishe lay. no the congestion and of and relieves mean order, septic A Chinese woman, aged fifty-one, field labourer, ruddy pain of inflamed piles, chiefly mucous surfaces, while every
of