Jacob Bell
New Member
CASE OF TRAUMATIC TETANUS EXHIBITION
OF THE EXTRACT OF INDIAN HEMP
(CANNABIS INDICA)-DEATH-AUTOPSY.
By JAMES INGLIS, I.D., Halifax.
TO THE EDITOtl OF THE PROVOMCIAL MEDICAL AND
SURGICAL JOURNAL.
SIR,
I believe that no one can leave the bedside of a teta,.
nic patient without a regret that; after having done
much to alleviate, so little'ultimate good can often-be
effeeted, atd that although pain itself may be subdued;
yet that the disease too surely progreses, and is finally
to conquer. Under such a feeling I am induced to
transmit for insertion in your Journal the following
case, being persuaded that it is no less our duty to
report our cases of failure than those of success; for
Whe case which terminates fatally, may be made, in
reference to others of a similar nature, as a beacon6d
warn and as a light to guide.
Such' prfatory remarks I am led to make, froit
having lately rbberved ii the,Laneet, or the` 14th "d
December, 1844, an-excellent retpu f it case -ofCte
aus,teminating fatally, t Guys Ho*ital, after the
exsibition of the Iidian; hemp, in hitherto iitiallet
ddoses. Had-I seen this case previous to the administration
ot it in tte ease foll'owing, I should have advised, after
decidibt upon the treatment, the use of the extract in
'n,h largr d-oses at the very commencement than we
gave, and--pellups should not have been induced to
trst SO implicitly to it, although I now feel satisfied
that any other mode of treatment would have
proved, in this instance, equally ineffectual.
CAsE.-John Fourness, aged 42, a stone-mason and
ni,ght-watch, married, residing in Lilly Lane, Halifax,
received,on Thursday, the 9th January, 1845, an injury
upon the middle finger of the right hand, by the falling
of e grave-stone, which crushed and fractured the first
pOalanx. He immediately applied to a surgeon, who
dressed the wound, recommending, at the same time, I
believe, the removal of the finger. On the Sunday
following, he went and had it again dressed, and for
the third time, on Tuesday, the 1 4th. From this
period he made no further visit to his surgeon, until
be applied on Tuesday, the 21st, to Mr. Swallow, of
this town, with whom I then saw the case.
We fo4nd him in bed, complaining excessively of
severe pain in the muscles of the jaw and neck; the
head was drawn forcibly backwards, and the jaw completely
locked; the eye-lids ivere rigid and semi-closed;
the pupils contracted ; the recti muscles of the abdomen
rigid. The bowels h!ad not been moved since Saturday,
and he had passed no urine for two days; we could
not see the state of the tongue; pulse 110; the tetanic
paroxysms occurring every five or ten minutes.
Notwithstanding the injury of the finger, he had continued
on duty as a night watchmnan even up to Sunday
morning, the 19th, when the pain of the face and neck
commenced. This had increased in severity till tl.e time
we saw himn, when he expressed it as excruciating, and
begged of us, if possible, to relieve the jaw. We imnmediately
informed both himself and his relatives of
his danger, and Mr. Swallow recommended that he
should be taken to the Infirmary. This proposition
being declined, we then determined, first, upon relieving
the bowels, and then upon the exhibition of the
gunjah.
The case I shall now report from my bed-side notes,
taken during each visit.
Tuesday, January 21, 2, p.m. To have immediately
-an enema of turpentine and castor oils, of each two
-ounces, in a pint of gruel.
5, p.m. The enema retained; has taken a grain of
the extract-no effect; pulse 130.
7, p.m. Enema has caused a copious evacuation of
kmTdaned scybala; has made a small quantity of highucor9uIed
urin, ibich deposits a lateritious z diwent,
re-soluble by pot water. Repeat the enema, with the
addition'of three drachms of tincture of assafetida.
-To have a grain of the gunjah in tincture.
10, p.a. Pq1s, 120i skin warm; perspiration on
head and face; enema retained; complains of hunger;
to have some wine and beef-tea, or broth. Repeat the
enema, and also the gunjab.
12, night. Repeat the guh.>, Wednesday, 4, a.m. Complains of great pain; no
appreciable alteration otherwise. Two Kaius given.
.2, a.m. Bowelsat moseed; pt;$i.ezMAal
11, a.m. Enewa returned, 1ll;pwwed ;r ao sn,a4
fetid evacuation, natural in appearance; very little
,effect from the gunjab; has pased about eight ounces
of urine, which smells strongly of the turpentinee;
body bent forcibly backwards, and arched from the
back of the head to the sacrum; the armbs and Iegs
are flaccid, and he retains complete power over them;
pulse 108. Repeat the en6ma of assafetida and turpentine.
Three grains of the gunjah given.
3, p.m. Expresses himself now as easy and free
from pain; is perfectly sensible; there is still great
rigidity of the muscles of the ba4k; he seems, however,
able to swallow better; the enema has been
retained. Three grains of gunjah repeated .
7, p.m. Bowels not yet roved; can -open the jaw
rather wider; expresses himnself as " very we)."
except that on each moveiment of the hand, the $nger
gives him great pain, and this seems to irritate him;
pulse 108; skin warm, moist and soft; has jus; taken
three more grains of the extract; deglutition very
difficult; bowels slightly relieved during the convulsive
attempt to swallow. After some effort, has made
about six ounces of urine. Mr. Swallow has removed
the injured portion of the finger.
(Urine.-Temperature, 601 Fahrenheit; sp. gr. 1.940;
copious precipitation of albumen on addition qf,_ichloride
of mercury; acid re-action on litmus paper.)
11, p.m. Feels comfortable. Repeat three grains of
the gunjah.
Thursday. 9, a.m. Since eleven last night, has
taken six grains, in separate doses of three grains
each; rambled very slightly during the night; is now
perfectly collected, and talks calmly of his state; says
he is without pain; opisthotonos is becoming more
decided; perspiration profuse over the whole surface;
bowels still unmoved.
11, a.m. There appears peculiar sensibility of the
ski; the hearing is particularly acute; perspiration
rather less; bowels confined; tetabio symytoms increase.
To have immediately four grains of the
extract, and a scruple of calomel. The attempt to
swallow this brought on a frightfully violent convulsion,
with rigid spinal recurvation; the arms and legs
now partook of the tetanic contraction; "eye-lids
forcibly closed; eye-balls, when examined, drawn upwards;
pupils contracted, and unaffected by light;
regsjmration quite suspended. -At this juncture, on
applying the ear to the chest, the heart was heard
faintly to beat; the wrist was pulseless. He remained
in this condition for full three minutes, during which
time we had recourse to continued unabated efforts to
compress and dilate the chest by manual force; at
length, deep, difficult, and interrupted inspirations, at
long intervals,were obtained, and very gradually respiration
was re-established. On recovering from this
paroxysm the pulse was 120, and soon became full;
all the muscles of the body became suddenly relaxed,
and he could without difficulty open the jaw at least
half an inch. By no persuasion could we get him
now to take anything by the mouth; we had therefore
,t6 hate recourse to enemata.
3, pm. Has taken a little broth with much difficulty.
Pulse 104; full and soft; respirations 31 in
the minute; surface of body warm, moist; pupil
natural; is quite conscious; says liP feels "very
well." Has had an enema, with two draclims qf
tincture, containing eight graina of the extract.-f
genjah.
5, p.m. No improvement; pulse 108. Another
enema given, containing tincture equivalent to twelve
grains of the extract.
11 p.m. Pulse 120; respirations 37; skin hot and
moist; can open the jaw a little; tongue dark, but
moist; quite sensible; says that he feels no pain, and
makes the same reply even when convulsed; he complains
of hunger and thirst, but cannot swallow much
from the recurrence of the paroxysms; he moves the
arims and legs when told to do so; had a small evacuation
after the last enema. There is no priapism,
neither has there been any tendency to it throughout
the case. To have a broth enema, with tincture, Containing
six grains of the gunjah. A piece of cloth
was now soaked in sto liquor ammonis, atd applied
along the cervical spine, which, upon vesicating, was
removed, and an ointment, consisting of two dramdis
of axunge, and a scruple of extract of gunjab, placed
upon the vesicated surface.
We left him at about twelve o'clock, after whieh
time he remained during the night in full possession
of his senses, expressing himself to his family as most
comfortable, both in mind and body. He continued
to speak in the same collected manner till within three
minutes of his death. The paroxysms continued
unabated during the night, and although the muscles
became flaccid before death, be was taken off in a
tetanic convulsion, at nine o'clock on the morning of
the 24th.
I am, Sir, yours, &c.,
JAMES INGLIS.
Halifax, Feb. 8, 1845.
Source: Case of Traumatic Tetanus Exhibition of the Extract of Indian Hemp
OF THE EXTRACT OF INDIAN HEMP
(CANNABIS INDICA)-DEATH-AUTOPSY.
By JAMES INGLIS, I.D., Halifax.
TO THE EDITOtl OF THE PROVOMCIAL MEDICAL AND
SURGICAL JOURNAL.
SIR,
I believe that no one can leave the bedside of a teta,.
nic patient without a regret that; after having done
much to alleviate, so little'ultimate good can often-be
effeeted, atd that although pain itself may be subdued;
yet that the disease too surely progreses, and is finally
to conquer. Under such a feeling I am induced to
transmit for insertion in your Journal the following
case, being persuaded that it is no less our duty to
report our cases of failure than those of success; for
Whe case which terminates fatally, may be made, in
reference to others of a similar nature, as a beacon6d
warn and as a light to guide.
Such' prfatory remarks I am led to make, froit
having lately rbberved ii the,Laneet, or the` 14th "d
December, 1844, an-excellent retpu f it case -ofCte
aus,teminating fatally, t Guys Ho*ital, after the
exsibition of the Iidian; hemp, in hitherto iitiallet
ddoses. Had-I seen this case previous to the administration
ot it in tte ease foll'owing, I should have advised, after
decidibt upon the treatment, the use of the extract in
'n,h largr d-oses at the very commencement than we
gave, and--pellups should not have been induced to
trst SO implicitly to it, although I now feel satisfied
that any other mode of treatment would have
proved, in this instance, equally ineffectual.
CAsE.-John Fourness, aged 42, a stone-mason and
ni,ght-watch, married, residing in Lilly Lane, Halifax,
received,on Thursday, the 9th January, 1845, an injury
upon the middle finger of the right hand, by the falling
of e grave-stone, which crushed and fractured the first
pOalanx. He immediately applied to a surgeon, who
dressed the wound, recommending, at the same time, I
believe, the removal of the finger. On the Sunday
following, he went and had it again dressed, and for
the third time, on Tuesday, the 1 4th. From this
period he made no further visit to his surgeon, until
be applied on Tuesday, the 21st, to Mr. Swallow, of
this town, with whom I then saw the case.
We fo4nd him in bed, complaining excessively of
severe pain in the muscles of the jaw and neck; the
head was drawn forcibly backwards, and the jaw completely
locked; the eye-lids ivere rigid and semi-closed;
the pupils contracted ; the recti muscles of the abdomen
rigid. The bowels h!ad not been moved since Saturday,
and he had passed no urine for two days; we could
not see the state of the tongue; pulse 110; the tetanic
paroxysms occurring every five or ten minutes.
Notwithstanding the injury of the finger, he had continued
on duty as a night watchmnan even up to Sunday
morning, the 19th, when the pain of the face and neck
commenced. This had increased in severity till tl.e time
we saw himn, when he expressed it as excruciating, and
begged of us, if possible, to relieve the jaw. We imnmediately
informed both himself and his relatives of
his danger, and Mr. Swallow recommended that he
should be taken to the Infirmary. This proposition
being declined, we then determined, first, upon relieving
the bowels, and then upon the exhibition of the
gunjah.
The case I shall now report from my bed-side notes,
taken during each visit.
Tuesday, January 21, 2, p.m. To have immediately
-an enema of turpentine and castor oils, of each two
-ounces, in a pint of gruel.
5, p.m. The enema retained; has taken a grain of
the extract-no effect; pulse 130.
7, p.m. Enema has caused a copious evacuation of
kmTdaned scybala; has made a small quantity of highucor9uIed
urin, ibich deposits a lateritious z diwent,
re-soluble by pot water. Repeat the enema, with the
addition'of three drachms of tincture of assafetida.
-To have a grain of the gunjah in tincture.
10, p.a. Pq1s, 120i skin warm; perspiration on
head and face; enema retained; complains of hunger;
to have some wine and beef-tea, or broth. Repeat the
enema, and also the gunjab.
12, night. Repeat the guh.>, Wednesday, 4, a.m. Complains of great pain; no
appreciable alteration otherwise. Two Kaius given.
.2, a.m. Bowelsat moseed; pt;$i.ezMAal
11, a.m. Enewa returned, 1ll;pwwed ;r ao sn,a4
fetid evacuation, natural in appearance; very little
,effect from the gunjab; has pased about eight ounces
of urine, which smells strongly of the turpentinee;
body bent forcibly backwards, and arched from the
back of the head to the sacrum; the armbs and Iegs
are flaccid, and he retains complete power over them;
pulse 108. Repeat the en6ma of assafetida and turpentine.
Three grains of the gunjah given.
3, p.m. Expresses himself now as easy and free
from pain; is perfectly sensible; there is still great
rigidity of the muscles of the ba4k; he seems, however,
able to swallow better; the enema has been
retained. Three grains of gunjah repeated .
7, p.m. Bowels not yet roved; can -open the jaw
rather wider; expresses himnself as " very we)."
except that on each moveiment of the hand, the $nger
gives him great pain, and this seems to irritate him;
pulse 108; skin warm, moist and soft; has jus; taken
three more grains of the extract; deglutition very
difficult; bowels slightly relieved during the convulsive
attempt to swallow. After some effort, has made
about six ounces of urine. Mr. Swallow has removed
the injured portion of the finger.
(Urine.-Temperature, 601 Fahrenheit; sp. gr. 1.940;
copious precipitation of albumen on addition qf,_ichloride
of mercury; acid re-action on litmus paper.)
11, p.m. Feels comfortable. Repeat three grains of
the gunjah.
Thursday. 9, a.m. Since eleven last night, has
taken six grains, in separate doses of three grains
each; rambled very slightly during the night; is now
perfectly collected, and talks calmly of his state; says
he is without pain; opisthotonos is becoming more
decided; perspiration profuse over the whole surface;
bowels still unmoved.
11, a.m. There appears peculiar sensibility of the
ski; the hearing is particularly acute; perspiration
rather less; bowels confined; tetabio symytoms increase.
To have immediately four grains of the
extract, and a scruple of calomel. The attempt to
swallow this brought on a frightfully violent convulsion,
with rigid spinal recurvation; the arms and legs
now partook of the tetanic contraction; "eye-lids
forcibly closed; eye-balls, when examined, drawn upwards;
pupils contracted, and unaffected by light;
regsjmration quite suspended. -At this juncture, on
applying the ear to the chest, the heart was heard
faintly to beat; the wrist was pulseless. He remained
in this condition for full three minutes, during which
time we had recourse to continued unabated efforts to
compress and dilate the chest by manual force; at
length, deep, difficult, and interrupted inspirations, at
long intervals,were obtained, and very gradually respiration
was re-established. On recovering from this
paroxysm the pulse was 120, and soon became full;
all the muscles of the body became suddenly relaxed,
and he could without difficulty open the jaw at least
half an inch. By no persuasion could we get him
now to take anything by the mouth; we had therefore
,t6 hate recourse to enemata.
3, pm. Has taken a little broth with much difficulty.
Pulse 104; full and soft; respirations 31 in
the minute; surface of body warm, moist; pupil
natural; is quite conscious; says liP feels "very
well." Has had an enema, with two draclims qf
tincture, containing eight graina of the extract.-f
genjah.
5, p.m. No improvement; pulse 108. Another
enema given, containing tincture equivalent to twelve
grains of the extract.
11 p.m. Pulse 120; respirations 37; skin hot and
moist; can open the jaw a little; tongue dark, but
moist; quite sensible; says that he feels no pain, and
makes the same reply even when convulsed; he complains
of hunger and thirst, but cannot swallow much
from the recurrence of the paroxysms; he moves the
arims and legs when told to do so; had a small evacuation
after the last enema. There is no priapism,
neither has there been any tendency to it throughout
the case. To have a broth enema, with tincture, Containing
six grains of the gunjah. A piece of cloth
was now soaked in sto liquor ammonis, atd applied
along the cervical spine, which, upon vesicating, was
removed, and an ointment, consisting of two dramdis
of axunge, and a scruple of extract of gunjab, placed
upon the vesicated surface.
We left him at about twelve o'clock, after whieh
time he remained during the night in full possession
of his senses, expressing himself to his family as most
comfortable, both in mind and body. He continued
to speak in the same collected manner till within three
minutes of his death. The paroxysms continued
unabated during the night, and although the muscles
became flaccid before death, be was taken off in a
tetanic convulsion, at nine o'clock on the morning of
the 24th.
I am, Sir, yours, &c.,
JAMES INGLIS.
Halifax, Feb. 8, 1845.
Source: Case of Traumatic Tetanus Exhibition of the Extract of Indian Hemp
