Case of Traumatic Tetanus Treated with Antitoxin Unsuccessfully

DARYAS {Singh, a vveii-built middle-aged Thakur, applied at the Etawah Dispensary for treatment of a wound in his groin inflicted by the horn of a buffalo. The wound was almost immediately below and parallel to Poupart's ligament on the right side, and in extent almost equal in length to that ligament. The injury had been inflicted some few days prior to his applying for treatment. It presented no special characteristics beyond an ordinar}r lacerated wound. The femoral vessels and nerves had escaped injury, and there had been but little haemorrhage. No attempt at cleanliness or protection had been made, but the granulations looked healthy enough. He was admitted as an in-patient on the 27th of September, the limb put on a Macintyre's splint, and the wound dressed with boracic acid and carbolic oil. On the 1st of October stiffness of the muscles of mastication and of the neck was complained of; the jaws could not be opened to their full extent, and there was some difficulty of swallowing. Tetanus was obviously commencing. A draught composed of chloral hydrat thirty grains, and bromide of potassium thirty grains, and with tincture of henbane one drachm was given every six hours. The next day there being no improvement, hypodermic injections of physostigmine grain were tried. Six injections in all were given, but without any change in the symptoms except that vomiting occurred after each. Recourse was then had to the original draughts. For two or three days his condition was practically unaltered, trismus being perhaps more marked, and there was hypersecretion of saliva. There were no spasms, no rise of temperature, and the pulse remained steady at about 96.? On the 7th of October a supply of tetanus antitoxin of the British Institute of Preventive Medicine having been obtained from Calcutta, one gramme was injected subcutaneously, and the chloral and henbane draught limited to two