Case of Idiopathic Tetanus. By D. G. Gregory, M. D.
of La Grange, Texas.
On Sunday, 15th Sept. 1850, I was called to see Miss Mary
Kefsens, aged 20, a native of Germany, who emigrated to Texas
in the spring of 1850. Says she always enjoyed good health ; com-
menced to menstruate at 13 years of age, and has menstruated regu-
larly ever since. Finding herself here without friends or relatives,
she went to live in the family of Mr. P. V. Shaw, of La Grange,
Texas. She was taken sick about the first inst., (after a hard day’s
work, washing and scrubbing,) with a chill, followed by fever, ac-
companied by severe paroxysms of cramp. Several physicians
of this place saw her, one of whom attended her for a number
of days, and from some cause (unknown to me) abandoned the
case. The above history I had from herself.
When I first saw her on the above day I found her presenting
the following symptoms, viz.: soreness and tenderness on pressure
of the whole spinal column, the least pressure upon the spinous pro-
cesses producing the most exquisite pain ; the most severe spasm,
affecting the whole muscular system, and producing complete
opisthotonos, trismus, and sometimes risus sardonicus ; tongue
slightly coated in the middle, clean at the edge; pulse and skin
natural; paroxysms coming on suddenly, and of about thirty
minute’s duration ; entire consciousness, and freedom from pain in
the intervals. I commenced the treatment by applying a blister
to the whole length of the vertebral column, gave quinine gr. v.,
morphiae sulph. gr. ss. every two hours ; enema of gruel and fourth
proof brandy.
Monday, 16. Symptoms same as yesterday; treatment same,
with the exception that I increased the quantity of quinine and mor-
phine, and as the bowels had not been evacuated last night, or-
dered an enema of tartar emetic in solution, suspended in gruel,
to be repeated in the afternoon. The blister having drawn well,
a strong solution of sulphate of morphia was ordered to be applied
to the blistered surface, and also to be repeated in the afternoon.
Tuesday, 17. Patient rather worse than yesterday. Slight
operation on the bowels, paroxysms longer in duration and more
severe, lasting nearly an hour, with emprosthotonos. Ordered Calo-
mel, gr. x. S. Quinise gr. viii., Morphise Sulphat gr. ss., every
two hours, and to be continued all day; enema at night of 01. Ri-
cini §i., suspended in gruel. At this time I sent for Dr. I. Evans,
my partner, as consulting physician, who, with me, attended the
case-until dismissed, cured.
Wednesday, 18. Copious discharges from the bowels last night,
slight degree of ptyalism, paroxysms not so severe as yesterday,
but longer in duration, (one lasting for the space of an hour and
a half) the intervals between paroxysms longer also. Continued
same treatment as yesterday.	k
Thursday, 19. Patient better to-day, considerable ptyalism ap-
parent, omitted Hydrargyri Sub. Mur., and continued Quinine and
Morphia, with Prussiate Iron gr. ii. added to each dose.
Friday, 20. Patient improving, treatment as yesterday. Co-
pious discharges of very offensive matter from the bojvels, at
intervals during the day and night.
Saturday, 21. Patient still improving, medicines discontinued,
ptyalism receding, patient sat up a little in bed.
Sunday, 22. Forenoon, patient a little worse, in consequence of
having exposed herself to a draft of cool air in an open gallery
yesterday; resumed Quinine and Morphia and gave it every
three hours.	' ■	' .
Six o’clock, P. M., was called in haste to see our patient; on
arriving found her much worse than on any previous visit, the
paroxysms being very severe, attended with the most excruciating
pain, extorting from her the most lamentable shrieks of agony; the
body and face distorted into every conceivable attitude, presenting,
alternately, opisthotonos, emprosthotonos, pleurothotonos, risus
sardonic.us, and trismus; her condition at this time was truly pitia-
ble. and none who saw her supposed she could survive more than a
few hours. Ordered Calomel gr. viii., Mor. sulph. gr. i., Quinine
gr. viii., every two hours, to be continued all night.
Monday, 23. No perceptible amendment in the symptoms, pty-
alism again increasing, bowels evacuated last night ; continued
same treatment as yesterday ; administered enema of 01. Ricini
§i., 01. Turpentine 5ss., applied a large-blister over the left side.
Tuesday, 24. More complete ptyalism, patient completely narco-
tized. Oil and turpentine evacuated the bowels, symptoms more
favorable, discontinued the Calomel;■ Quinine and Morphia as
before. -	•, »	. .' -
Wednesday, 25. Patient a great deal better; cramp confined
pretty much to the lower extremities; continue Quinine and Mor-
phia every four hours.
Thursday, 26. Still improving very fast, no spasm to day; patient
sat up nearly all day.
Friday, 27, to Sunday,29. Patient still went on improving, until
Sunday evening, when she had slight paroxysms, which were
effectually relieved by the application of a blister on the side, a
few doses of Quinine, and two doses of Seidlitz powders, during the
night.	. v '	'	•	'	- ;
Monday, 30, to Oct. 15. Patient has still gone on improving, and
expresses herself as well as ever she was.
Remarks.—I consider the above case one of idiopathic tetanus
of miasmatic origin. The most remarkable feature in the symptoms,
was the excruciating pain attending the paroxysms, and their
always commencing in the left side; and that most remarkable
in the treatment is the enormous quantity of calomel and quinine
taken before ptyalism was induced, and the circumstance that
whenever it was, the symptoms were alleviated.
La Grange, Texas, Oct. J.5, 1850.