Case of Traumatic Tetanus cured by the inhalation of Chloroform.
By Dr. Th. V. Dusen, of Mannheim.—A patient, aged 26, ran a nail
into the great toe of the left foot, on April 17th. On the 30th, he ex-
perienced difficulty in opening the mouth. On May 2d, the masseter
and other masticatory muscles were contracted, and the mouth was
closed. On the 5th, the symptoms were more severe ; and on the 6th,
there were tetanic spasms, returning every five minutes, combined with
opisthotones. Morphine, bleeding, tobacco enemata, cupping, etc., were
tried without avail. Pulse 112 ; skin warm. Chloroform inhalations
were then directed. The tetanic symptoms disappeared during the
narcotism, and the patient obtained some rest. Upon the return of the
spasms, the chloroform inhalations were repeated, during which the pulse
sank from 110 to 60. The author now endeavored to keep the patient
in a state of constant excitement, and administered, between this date
and 20th of May, 64} ounces of chloroform.
21st.—The inhalations were discontinued; cold was applied to the
shaven head, and a quarter of a grain of acetate of morphia was given
every two hours. On the 4th of June the patient was well.
Dr. Bargigley of Lesbos, relates the case of a countryman, in whom
tetanic symptoms came on after the ex-articulation of the third finger.
The patient was cured by the same treatment.
A similar case is related in Langenbeck’s Clinic.
The death of the patient in tetanus is caused by the cramps extending
to the respiratory muscles and to the heart. It rarely occurs from loss
of power in the brain or spinal cord, or from exhaustion. The course
is usually acute, the tetanic symptoms ensuing in the following order:—
trismus, cramp in the muscles of back and neck, the extremities often
remaining free. Most patients die before the twelfth day. The prog-
nosis is the more favorable the longer the disease lasts. The advantage
of narcotising remedies consists in this, that the tetanic cramps become
suppressed or rendered milder, and thus the respiratory act and the con-
tractions of the heart proceed unimpaired. Chloroform, from being
taken into the blood direct from the lungs, is preferable to all other nar-
cotising remedies, which must be absorbed from the stomach. The
effects of the chloroform inhalations must be continuous, the patient re-
maining days, and even weeks, more or less, under its influence, until a
point of saturation is attained, characterized by the rapid production of
the extreme narcotising effects, the patient during the intervals being in
a state of obstinate excitement • head hot, face red, eyes glistening, fre-
quent epistaxis, etc. Atmospheric air was mixed with the chloroform
in Dr. Dusch’s case.—Med. Times and Gaz. from II. und Pfs< Ztschr.,
N. F. III. 1852.