fucceeded by others, fo that the complaint had confiderably increafed of late. She was ordered to dress the parts affected morning and evening with lint moistened with fweet oil, and to take eight drops of Fowler's mineral folution three times a day, in a little water. This treatment produced an immediate and rapid improvement in her fituation, and was perfifted in fix weeks, when she became entirely well. Two years have now elapfed fince the cure was effected, without the least return of the disease; nor have any ill confequences followed the long continued ufe of the medicine.

Yours, &c.

J. C. OTTO.

Philadelphia, July 21, 1804.

Hiftory of a Cafe of Tetanus, in which large Quantities of the Tincture of Cantharides were ineffectually employed. By JOHN REDMAN COXE, M. D.

LIJAH DUNN, aged fourteen years, was admitted on the

ELIJA

feventh of June of the prefent year, into the Pennsylvania hofpital, for an injury just received by a fall from a horse. A wound on the inner fide of the right tibia, nearly two-thirds the length of the limb, and of confiderable depth, together with one, on the outer ankle of the left leg, but little more than fkin deep, formed the extent of the accident. Both wounds were dressed with futures and adhesive plaisters, to favour union by the first intention.---No fever or inflammation fupervened; and the pain, confidering the extent of the injury, was moderate. As he was bound in his bowels, on the ninth he took an ounce of Glauber's falts, which operated plentifully. The wounds were examined on the thirteenth, but no union was obferved, and the discharge was profufe, but not purulent.

On the fourteenth one drachm of bark with ten drops of elix. vitriol. were ordered to be taken three times a day; and the wounds were dressed morning and evening with poultices sprinkled with laudanum: by the feventeenth, the wounds affumed a more healthy appearance, granulations began to rife, but were foft and rather of a pallid hue, the discharge was thin and white, and a cicatrix had commenced. At this time he observed a difficulty of moving his lower jaw, but gave no information of it until the eighteenth, when the bark and vitriol were omitted, and one grain of opium was ordered three times a day, with a quart of white wine in the twenty-four hours. The disease. feemed ftationary till the twentieth, at which time he opened his mouth with difficulty, and complained of stiffness of the mufcles of the neck and abdomen, (which Taft were now nearly as unyielding as a board,) with flight fpafms through the day. The wine appeared to exhilarate, and keep him free of that violent pain at the fcrobiculus cordis, in general so fevere in tetanic patients. The opium was now increased to a grain every two hours, and the wine ordered ad libitum. Spirit of turpentine was applied to the wounds, but excited no pain. It was then applied boiling hot, and even mixed with falt once or twice with fcarcely a fenfation of pain.---In the evening the fymptoms had increased: thirty drops of tincture of cantharides were now given every hour, till he had taken four dofes, when violent pains of the ftomach and ftrangury, rendered its exhibition improper. The fymptoms abated from the time this effect took place; but a tightness at the region of the ftomach continuing, induced me to order a mustard poultice, with relief. Cantharides in powder were applied to the whole furface of the wounds, in hopes of exciting a more vigorous action in the languid vessels, but without effect. The pulfe was increased in frequency, but diminished in force.

21ft. The symptoms of ftrangury, &c. no fooner fubfided, than the tetanic fymptoms recurred, with permanent contraction of the mufcles. The pulfe beats one hundred and twenty, and weaker, and a degree of rifus fardonicus exifts. The jaws were

clofe contracted, and the head was drawn confiderably backwards. Ordered to apply flour of muftard to the fores, and take every two hours ten drops of tr. cantharidis in a glass of wine; continue the opium every two hours, and inject at the fame interval of time, thirty drops of laudanum in two ounces of wine diluted with water, up the rectum. If no effect is produced by the mustard, apply the butter of antimony to the fores.

22d. The butter of antimony was partially applied last night and repeated this morning; the pain was confiderable, but the action of the veffels was fo torpid, that the flough was not feparated for several days. The symptoms have abated: about three pints of wine have been taken by the mouth, and in the injections, and about 3ij. of tr. of cantharides, producing a flight ftrangury and pain of the inteftines. He had one confiderable convulfion last night, after which he flept a little.

23d. Last evening had a violent convulfion. His pulfe is fuller, and his face is flushed apparently from the wine taken; in fwallowing his medicines, &c. he is obliged to be turned upon his belly, refting on his elbows, his head being drawn backwards confiderably; and he is obliged to fwallow flowly, to prevent a regurgitation of the fluid through the noftrils. He cannot now take the folid opium, I therefore ordered fifteen drops of laudanum every two hours in his wine; and as he has had no ftool fince the nineteenth, the wine injections were omitted for the present, and a common purging enema was administered. He paffes his urine more frequently, but in fmaller quantity and high coloured, with fome fcalding; it is however under his perfect control. The fores are tender, with a flight difcharge. Continue the wine and laudanum, and increase the cantharides to thirty drops. If the ftrangury is not increased by the evening, apply a large blifter to the region of the pubes. His food is chiefly panada, made rich with wine.

Although his jaws were closed when awake, yet in fleep a complete relaxation of the muscles took place, the jaw falling upon the breast. But the tongue, which was perfectly still when awake, was, during fleep, in a constant ftate of fpafmodic action, resembling the motion of the tongue of a snake. This was not however invariably the cafe.

24th. The rigidity of the mufcles is now univerfal, though he fuffers but little pain, except when a violent convulfion feizes him, when his cries may be heard at a confiderable distance. His mouth is opened with difficulty, and he bites his tongue frequently during fleep.---Pulfe one hundred and eight; he slept tolerably, the glyfter operated well yesterday, and the wine injections were refumed at five P. M. He does not retain them well; I therefore ordered them in diminished dofes; viz. 3fs. of wine and as much water, with forty drops of laudanum. About a quart of wine has been used fince yesterday. The blifter was applied as directed, and rofe well with confiderable pain, but no increase of strangury. Ordered fifty drops of tr. of cantharides, and thirty of laudanum every two hours.

25th. Butter of antimony was applied this morning over the whole extent of the fores, producing great pain of short duration; fkin is generally moift, and he appears flightly better, opening his mouth wider.

26th. Half past nine. The fymptoms were aggravated; about five last evening a violent convulfion seized him. He does not take as much wine as is defirable. Slight spasms attack him every five minutes; a miliary eruption has appeared, chiefly about the neck and body; pulfe varied much during the day, fometimes full and flow, at others, weak and frequent. Pledgets of linen constantly wet with brandy were applied to the fores. A glass of wine was ordered every hour, and the tinctures of cantharides and opium as before. If no effect occurs by noon, give fifty drops of laudanum every hour with the wine, and fifty drops of tincture of cantharides. Increase the laudanum in the glyfters to fifty drops.

By noon the increased dofes were commenced, and perfevered in, till he had taken about four hundred drops of laudanum and as much cantharides, and half the quantity by injection. At fix P. M. a violent convulfion attacked him, lafting half an hour, and he began to grow comatofe, with now, (8 P. M.) a degree of stertorous breathing, and that extreme irritability produced by laudanum, awaking if touched, in convulfions, and affected

with frequent tremors. No relaxation of the jaws; the pulfe is good. Ordered to omit all his medicines; to apply a large blifter over his head; and if the fymptoms of coma, &c. increase, give 3fs. of white vitriol and as much ipecacuanha in divided doses, to excite vomiting. Should the convulfions increase, by ten o'clock, dash over him two bucketfuls of cold water, and repeat it if ferviceable, every two or three hours.

27th. 10 A. M. Blister drew well. The attendants kept him conftantly awake; and in a few hours the effects of the laudanum fubfided, though he yet continues very drowsy. The jaws are still close; but on the whole he seems better. He makes water often, but in fmall quantity with fome fcalding, and high coloured, which is all the tendency to ftrangury that has occurred fince the firft dofes of cantharides. The tr. of cantharides was again refumed in dofes of one hundred drops every hour, until by fix P. M. he had taken one thousand drops, without the flighteft effect apparent. It was therefore discontinued altogether. Wine was ordered ad libitum in the evening, and fifteen drops of oil of amber to be given every hour, augmenting each dofe: he took but one dose, as he said it nearly ftrangled him, and would not try a fecond.

28th. This morning he began early the use of volatile alkali in doses of five grains every hour: three or four doses have been taken without any visible effect. He had one violent convulfion last night and two this morning, at other times remaining free of pain though quite rigid, and having frequent twitches of the mufcles. The fores are more inflamed around the edges, with confiderable pain when touched, the fenfibility appearing to be perfectly morbid. During the night the urine. came away involuntarily. He has now however the complete command of it. I now determined to try cold water by affufion, in which I was fanctioned by Dr. Rush, who came in at this period; his pulfe was one hundred and four and tolerably vigorous. At noon a bucketful of cold water was poured through a cullender over him as he lay in bed, on an oil cloth, and he was fuffered to remain in it for two minutes, before he