An account of a remarkable case of the tetanus

NATIONAL LIBRARY OF MEDICINE

Bethesda, Maryland

*. N

ACCOUNT

OF A REMARKABLE CA

TETANUS.

NO R IV I C II:

tid by Thomas Hun'

M.DCC.XCIV.

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7i £tffltfr PHILIP TURNER.

Dear Sir,

I PRESUME }0U will rr-mcniher mv frequent conver-
fation with you on the tubject ot a Gngularcomp
Which took, place in mv father's family. I ha\
up an account of this diforder, with the fyftem i
ice purfued, which I offer tor publication, and with roar
.•eave have the honor ol inf< : ; to you.

Since every diforder muft have a name, and as I con-
:r the one in (rue ft ion to be the fame from the begin,
ing, for i: I have made ufe of the term Te'I , s
der this, I muft comprehend a great vatiety of d
and ieemingly contrary lymptoms. If there is any ■
name, that will better comprehend all the fymptorns which
Lave been ranked in the train of fpafmodick uid

fome, which, I am almoft willing to believe never before
obtained I would gladly adopt it.

I am fenfible of the danger there is in telling largejlo-
ries. Whatever ona may be made, 1 (hall not

be concerned while 1 know that I can tef-

timonyofa coniidcrablc number ot re perfbni

who were eye witne flies of mo ft of tie Fa£is I have re-
lated. I have to reg. apt havi r i<; kept a regular
journal of the diforder from firfl to laft. jHad I taken
this liep, I might, perhaps, have given ac-
count. However, as I jr. e houfe with th<
dent during the grtateft part oi her i ln< fa, and, u
my father, in quality ol phj Reran-, w*-, a principal ;i
d; nt, it will not be doubted, that I had me b( (J poi
opportunity for o i i.and moftol the fail
were calculated indelibly to irnprett the mini. So far do
A i I

I think rayfelf, from being impofed upon by imagina-
tion, that with confidence I can now fay " the whole has
not been told." The pi&ure is far from being perfect,
and, to make it fo, is not in the power of language.

What advantage will be derived from my having gi-
ven a general plan of the method of cure, I (hall not pre-
fume to judge. This ftep was hardly to be avoided, and
I hope it will meet the approbation of fchofe of the Fac-
ulty elpecialiy., into whole hands this mite may chance to
fall. — ou much ot it as may have been detrimental, I
hope will not be imitated when ?. fimilar occafion of-

U ■ !.

'.: the Angularity of the fymptoms. d'ifcribed, a re-.

■ ; for the advice oi friends, a delire to afford fatif-
Uctiof) to excited curiofity, with the profpect of iome
little advantage to mankind, and the ambition of tranf-
mittrpg to posterity a cafe-unparalleled in hiflory ; if thefe
area fufficient : excufe for making public the fubitance
of the following pages, I fhall need no apology.

Accepting my hearty wifhes for the welfare and
prosperity of yourfelf and family, whom I fhall always
efleem, permit me to mention my gratitude for the re?
peated alliances of your kindnefs to your
fincere friend
and Pupil,
THADDEUS CLARK.
Lebanon^ April t 22, 1794.

SOME

SOME notes are added, TTjo form
of them to Phyjicia?7s ?nay prove fuper~
jluous,Jliil I hope they will not be entire-
ly ufelefs,

4'

An ACCOUNT
of a remarkable cafe of the

TETANUS.

HE fubjecl of this complaint was Polly
Vaughn, a girl of feventeen, of a confu-
tation, formerly ftrong- and robnft, too much
confidence in which at a critical period of life,
may have led to thofe imprudences, that may
well perhaps be ranked among the cauies of her
fcarcely paralleled diflreffes.

The patient, at the time of her extreme I II—
nets, was a member of my father's family. She
was one of the poor of the town, and, when quite
young, was bound out to, and ever fince till {he
came to live with us, had ferved the perfon by
whom a confighment of her indenture was
made. She was fupnofed to be, a" firm, hear-
ty, well girl :" loon after {he came into the
family, however, (lie was confined by the disor-
der I am Ibon to defcribe.

A conlrderable time eiapfed before the com-
plaint difcovered its real type, and we were
much in the dark concerning its true character.
It was at fir it fuppofed to be wholly, the effecl of
catching cold ; the patient having been expofed
by wetting; her feet ; but full conviction of the
fallacy of this idea afi erwards arofe

I ft. Fr<>m the lingulariry of the fymptoms,
and the effect of taking; cold fo .univerfally at-
tendant on the fex not having followed.

2dly

2ly. From a knowledge of her former ha-
bit. Whether from inclination or what ever
fource, fhe had formerly been acuitomed, to go-
ing barefooted, in cold weather, frequent wet-
ting her feet, being out in the J now barefooted,
for hours together and other like imprudences.
The circum'rances, to which many (till attribute
the complaint washer wetting her feet : though,
compai itively me was (lightly expoled to catch
cold, and other things render it very improba-
ble, that this was a principal caufe : if (lie was
" a firm hearty well girl," why was (he never
affecled in this way before ?

g>Jy. From the nature of the complaint
itfclf. The TETAMjS, is a diforder of ex-
treme debility § in the nervous iyitem. The
cauies of this debility, are, pain and irritation
from the wound of a nerve or tendon : inanition
from lols of blood, protuie evacuations, or

caufes,

% The great fx*rior« of which the futjeft of this comprint
is fo'TtiiK** cap ble. anJ the violent contraction! of the ronf-
fle's, ho "ever inexplicable oa anv other princiole, are no ob-
jtftio" to uV UMlk of this pofiion. That t-is c'iforder pro-
cess f cm debility is evident, fom the canfel th.it pretend,
the irfif 'the, J I bilii tinj plan of cut*, and the invito.

n tii wnft the orlv fu cehful. (See Brown's Elements

ofmeHi i c ) Till within -a fa* yp.irs, in this complaint, luge
evaruaiio s w re universally admitted : bui lafr improve-
ment -»• d *i ; < experience fh» r>f a
rtm'dy '•' :> iuffkient to prepuce the dii'calc in a
nujvcl Jready oifpofed.

caufes, that prevent a due reftitution of the wafte
in the circulating mafs ; ^f cold and fatigue,
with other caufes attendant on a military iife.
Unlcfs introduced by the violent operation of
one or more of thefe caufes, it never was known
to come on fuddenly. As no one of thefe caufes
obtained but in a flight degree, where muft we

iook

qj The '• caofes that prevent a doe reftitution of the wafte ia
the circulating nnfs" are fafting, too fcantv a diet, indigeftion,
and a habit of ejecting the contents of the (tomach by puking t
the two Iaft are equally confequences of indnced debility. In
four cafes of the Tetanus which I have frn in female fubjr&j,
two were obvioufly produced by frequent blood letting for
pains in the fiJe and other ailments that clearly depended on
debility for a confiderable time fixt in the confiitution, A cau-
tion for my female friends, Another cafe was introduced by
very imprudent profufe blood letting for a flight hyflerick af-
fection broughton by catching cold, on a girl of feventeen. In
all the inftances except the 1 aft mer tioned, thediforder. through
a feries of debilitating cauf;s, and fymptoms of debility, might
be traced back many months, or even yean. When debility
is once by any meant induct d, perhap.% what is vulgarly called
catching cold, is the monVconmon exciting caufe of the com-
plaint ; particularly in female-;. Another ciut'»on. Whv this
diforder, urdefs brought on by fome fudcen, and violent c?ufe,
obtains more frequently in the female, than male branch, of the
commur.ii* U not necefFry toe-quire. 3t is remarked by
fome, that thisdiforderoftoer ffl cl> the/pcrrrcl £ of p oplethan
any other: All the inilancf ] hive quoted were of t^is flatup;
the iubjefls, r.ll ^ut one hivin been bound out bv the town un-
der the ^larafter of iotun'* poor. What is the rerfnn ? fuch,
generally fpeaking, *re leis controoled by the Ariel ru'es of
fan;i' . diLii ■■lln , cfpeiiaMv w l en t k ev arrive to years of matu-
rity, the rnoft c iucal part of hfr ; to ufe a common^xpreflion,
•* They love to Have 'Vir own w»vs." confequcnrly they are
jnoiein thewav of thofeir»crudences,<and more liable to tr.ofe
accidents - hich tend to pro'ueet • complaint, and to which
their fiiuaiion in oilier refpetts expofes them.

look for the foundation of the complaint? muifc
it not lie in the gradually declining ftate of an
impaired cooftitution ? whether this condition
was produced, by the abufe of an uncommon
{hare of bodily ftrength, by lifting, by hard la-
bor, frequent expofure to vet ami cold, and o-
ther habitual imprudences, is not necefTary to
enquire «

WBiiKwe ctme to examine into the ftacc of
the patient's health heretofore, sv e found,

ift. Th \t Ric had been fubjecl to the afthma
from the eighth year of her age, which afflicted
her as often as (lie took cold or fatigued her-
fel beyond her firength. This affection had grad-
ually increa fed "pon her from its commence-
ment, and was much more fevere, and recurred
mere frequently the laft year than formerly.

2d. During two or three of the years laft paft;
her conftitution fhewed evident figns of de-
rangement : thefe were pains in her ftomach and
fide, flight cramps in her extremities, and other

vous.co '■' pains in herftorfl

and fides, had likewife from their commence*
rcafed in violence, and the frequency
of their re ce, and were likewife bro"

on by fatigue oi taking cold. According to the
teftimony of herfelfand others in the ho
~re fhe formerly had lived, when the parox-
, of p in in the ftomach and fide were mod
fevere, me was, t4 time and again,'' ieen c ramped
down on one fide, and rolling in diftrefs on the
fioor. It may be well to notice, that the fyi
toms generally came on in the evening. An in-

fuf. ,

so

fufion of pennyroyal f>r mullen blows it isfaid
generally afforded relief and inthc morning fbe u-
fuady went about her work ; fometimes fhe
would continue unwell for feveral days.

3d. Another difficulty that attended w?s, fre-
eusnt puking, to this (he had been fubject but for
a few months. The affection had never been vio-
lent, & attended irregularly ; fovnetimes the pa-
tient being entirely free from it for the term
of a fortnight, for the moft part it only opera-
ted to eject the contents of the ftomach after
eating, whi h it did occafionally every day for
nearly a week together. This iymptom like-
wife grew upon her ; fne perceived that her con-
ftitution was failing ; fhe v/ould often expreis it
to her rfTodates, and fay, that "fomething dread-
ful was going to be the matter with her ;" thai
fhe did not believe fhe fhould " live till me was
eighteen years old."

On the evening of the day, in which her fer-
vice in the family of which fhe was a member,
during the feverity of her illnefs, commenced,
fhe had an attack of the afthma. — She bad been
taught to call it; the Phthfiick ; her pains, & the
fymptoms above mentioned not ieldom recur-
red. She was almoft every day complaining :
but fuch had been the reprefentation of her
character in point of veracity, (whether juft or
unjuu: I need not fay, let others judge) and fo
peculiar was the genius and dilpofjtion of the
girl, that her complaints did not always gain cre-
dit, and little, or nothing was exhibited for her
relief.

CoiUMRINf?

n

Covp.-mrae thrs plain ftatemcnt offals, with
ttic diiorder at its firft period, and afterwards,
not a doubt can remain of its having exifted for
a long time in embrio, The germ, deeply bu-
ried, and foftered in the conftitution, was juft
ready to burft into life, and only waited the in-
tervention of an exciting caufe.

Unfortunateiy, a knowledge of thefe things,
from which, perhaps, would have foil-owed an
unequivocal diagnofis of the complaint, on
which, it is poffible. fuch treatment might have
been predicated as would have arretted the dis-
order or rendered its progrefs lefs diftrefting,
did not tranfpire early enough to afford any
advantage.

The patient, as I have faid kept complaining.
About the fecond of February I793> (he took
cold. A dyfpnea, pain in the head ,ftomach, and
fide ; naufea, flight fpafms in her fingers and
toes, 3c hyfterick fymptoms followed. A gentle
emetick was given, which operated kindly,
and at night, an anodyne. A fortnight elapfed,
during which time (he feemed gradually to
mend, but dill required the attention of a Phyfi-
cian. The afthma, and pain in the fide return-
ed in the evening at intervals. The puking a-
bove mentioned, forfome weeks having increaf-
cd rapidly, was now grown very troublesome.
The patient, apparently retained very little up-
on her ftomach. Weak, and imprudent, after
exercifing herfelf beyond her ftreugth, (he was
taken down again with redoubled violence.
Pains in the prim^ viae, in the fide, and variom

other

12

other parts of the body ; nauTea, vomiting with
little intermiffion, dyfpnea. and delirium almoft
to madnefo obtained. During the night, by
the help of an opiate, (he received fome reft ; in
the morning the delirium had fubfidcd, but the
affc&ion of the ftomach and bowels increafedc
From this time the diforder appeared to be fixt
in the ftomach and right fide, and for eighteen
days the naufea was fo extreme, as to render
impoflible in a natural way the internal ufe of
medicine, or fuftcnance. The diforder rapidly
gains ground, and her diftrefs becomes racking
beyond expreflion.

She now complains of a burning, as from
coals of fire in the right hypochondrium, her
vomiting, or rather reaching to vomit, became
almoft incelfant. The unremitting pains (lie
endured, with various other circumftances of
diftrefs, rendered her an object truly deplorable.

The delirium ufually returned in the after-
noon, and continued, with (hort intervals of
rationality, till late in the evening. In the fore-
part of the day, the patient, had generally the
free exercife of her mental powers, except
when a delirium was brought on by lev ere par-
oxifms of pain, at which time (he would often
plead heartily to have her bowels taken out.

About four days after this laft attsf k, a tumor
of confiderabie fize, attended u ith a flrong pul-
iation, rofe, over the right hypochondrium, the
pl-ce where the pain had formerly been, and
ftill continued the mod acute : this gave rife to
the alarming idea of an approaching impofthu-

snation

mation. However, as no iip/.is of a general in-
flamatory diathefis were obferved, no material al-
teration in the method of cure was at this time
thought adv if able. The patient never hadbecu
let blood during her illhefs. Her pulfe, was
weak, quick, and irregular, every thing increas-
ed our perplexity.

The pediluvia, fomentations of the fide, fto-
mach, and even of the whole body, (as a iubfti-
tute to the warm bath, which in this cafe, in the
prefent ftage of the complaint, from peculiar
circumftances was rendered impracticable) em-
brocations, and injections, feemed the only
means of relief, and they were liberally fuppli-
ed. The embrocation made ufe of, was a com-
pofition of camphorated fpirit, oil of amber,
ipirit of fal ammoniack and thebaic tincture :
the injections were nutritive and anodine. Such
however was the irritability of the fyftem, that
the mildeft efforts to procure relief, were uni-
formly attended with painful paroxifrns of
reaching and vomiting : means, were ne- erthe-
lefs punctually puriued, but what their fuccefs,
is hard to determine.

Isr this condition, with little variation, the pa-
tient continued for fever al Succeeding days.
The puliation at the fide now ceafed at once,
and the pain* and other fymptoms having fub-
fided, Ihe realized a few moments of del u five
eai

An extraordinary circum fiance now occurred.
The patient was fo well as to be fetting up to
have her bed made, when an alteration equally
B iuclden

li

fudden and laiprifing took place; her own ex-
preffion was " I am afraid I am dying." She
was inftantly laid upon the bed, and notwith-
itanding every poffible afliftance was afforded,
in a moment, funk down, and was fpeechlefs.

From the prefent lituation of the patient and
the previous appearances, how far were we au-
thorifed to infer that this phenomenon depend-
ed upon the rupture of an impofthume ? extre-
mities cold ; pulfe weak, and fliittering / and al-
inoft a total fufpeniion of the vital principle ob-
taining for more than five hours, fcarcc a ray
of hope remained. She was more than once
thought to be quite gone: but at laft gradually
revived, continued extremely feeble for ieve-
ral days, and about funfet, or the time at which
fhe was firft affecled in this way, fhe had a re-
turn of this Singular paroxiim : I take the li-
berty to call it %.fyncope.

As the laft mentioned fubflded, a train of
fymptoms, as extraordinary perhaps as any up-
on record, fucceeded.

The firlt, was a curious condition of the res-
piration ; a condition very difficult to be des-
cribed : perhaps it proceeded from a convulfive
Hate of the in u Seles that fubfervethis function:
m*od«( Lag deep inspirations and expirations (the
latter always produced in a heart rending
grv>an) which recurred at intervals ofaminute.
This Symptom likewife returned periodically,
and was followed with themoft obftinate, com-
pletely formed fits of the Epilepfy.

Thf.

THEEpilepfy alfo, returned about funfet, and
for the mod part continued through the night.
Sometimes, if inceflant foaming at the
mouth, and fpaftick rigidity of the whole body
are pathognominick fymptoms, thele truly roe*
lancholy and horror finking fits, performed a
rout of fourteen hours. Thefe followed I
regularly for four or five days : happy wo
fhe have been, had fhe lVen, in this laft afflic-
tion, the concluhon of her milery. Between
fits, the patient was exercised with univerfal
diftrefs. In the forenoon the affection of her
ftomadi and bowels obtained : in the afternoon
it was not fo acute : flight fpafms feizel the
mufcles of the neck, jaws, and extremities : fi
quent fighing and fobbing attended ; and thefe
laft, with the fingular affection of the organs of
refpiration above related, ufually ufhered in an
Epileptic!: fit.

To the Epilepfy, fucceed all the horrors of
the Tetanus, or what is vulgarly called cramp
convull'ms . Its paroxisms, the intervals of
which (the affection of the (romach and bowels
continuing) held forth a variety of mifery ra-
ther than any pofitive comfort, were the mod
acute. The patient is (ii!l unable to fw allow.
The whole tribe of fpafmodick fymptoms as '
tingulfhed by authors under the names, || Era-

proilbotbnos

|| Emprosthotokos. Tl "i obtains wher the

ii rigidly bent fa rd ( Piai otonoi : in it the
body is ri: backward. In the Pi.eurosthoton-

©s, the bod) ifcbei bead Uuw dt th« hip : Doc-

tor

16

profthotonos, Opifthotonos, Pleurofthotonos.
Catalepfy, Trifmus ; and indeed, if I may be al-
lowed the expreffion, every poffible variety of
fpafmodick or convulfive afteclion were clearly
exemplified on this miferable fubjecl. So irre-
gularly thefe phenomena fucceeded each other,

that,

tor Cult. en mentions this as being a very rare occurrence.
Cat kLEi sy. With thefe fingular fits the patient was attend-
ed as often as fifteen or twenty times. The following difcrip-
tion is taken from Mot herb y's Medical Dictionary.
" In this diforder the patient is fenfelefs and motionlefs con-
tinuing in the pofture the fit attacked him in until a recovery
from it. The limbs are movable by another perfon, but how-
ever they are difpofed, the patient never alters their pofition un-
till the paroxifm is at an end. He neither fees, hears, nor feels,
whatever method may be ufed to excite the fenfations. He
fwallows greedily all that is given him : his eyes are open and
feem fixed upon fome object, at the clofe of the fit he fetches
a deep figh and then recovers." The prefent inftance dif-
fered confiderably from the above defcription. The patient
wr.s not always fenfelefs ; me fometimes heared, and knew
every thing that was faid and done, and when (he came out of
the fit would often give an account of the Tame, and attempt to
delcribe her feelings when in this fingular condition. She was
Bniformly unable to fwallow, and was totally deprived cft'ne
ufe of every mufcle. ihofe that fubferve refpiration hardly to
be excepted Open her mouth, or eyes, and for ought the
patient could do, they would remain open. Shut them, and
{he was unable to open them. The patient in thefe fits
w.is not unlike an image of foft wax, which you m?.v bend
into any (bane or pofture, and it will preferve the condition fail
impofeo. She has told me, that, when thefe fits were upon
her, die was perfectly free from pain, experienced a fteepy
numbnefs over the the whole body, and " felt in a kind of a
i • . vw:M " The TRISMUS is what is vulgarly called the
Locked j. >w. All thefe fymptoms, tho' treated of by au-
thors as (liuinct complaints, perhaps the CATALEPSY may
be excepted, are not Hfcntially different, and may be compre-
hended under the general term of fETANUa.

17

that, with regard to them, it is invpofiible to be
particular. We were fully convinced that the

complaint had been wholly Spafmodick from
the beginning, although three refpetrable gen-
tlemen of the faculty had heretofore given their
opinions in favour of a local incarnation.

From this time for three weeks, the patient,
at a time for the fpace of five minutes was hot
free from the cramp in fome part of her hotly.
While afleep, her limbs were generally fo cram-
ped as to be inflexible. Awake ; her tongue
i* now drawn down her throat ; again, it is pro-
truded out of her mouth its whole length, at
which time, her jaws fpringing together like a
fteeltrap, afforded a fpetracle ihocking to be-
holders. Fourteen, fixteen, zv.d even eighteen
times in a day, fhe was fo cramped backward,,
that her head and feet completely met ; and, at
times her feet projected bey or d her head two
or three inches : her toes now lapping over up-
on her forehead, and now curling down on the
back part of her head ; the fpalm then feizing
the antagor.ift mufcles, fhe was bent in the fame
proportion forwards. .Sometimes an univerial
rpafm of the external mufcles taking place, the
iVLjecr. lay extended ftiff and moticnlefs : this
circumftance ufually preceded an Epileptick
fit, in thole irregular fits of the Epilepfy that
took place after the commencement of the TE-
TANUS. Hickupping, involuntary laughter,
grinning, horrid diftcrtions of the countenance,
(the eyes rolling round in their lockets, fo.as
that the diicolored parts were almcfl totally

B 2 obicurcd)

obfburcd) variegated the fcene. The fpafm
retiring, as it were from the limbs, and fixing-
on the urinary pafTages, flomach, and appenda-
ges ; a painful Ifchiiria, with the mod excruci-
ating agony enfued : (he raves with madnefs
and attempts to deftroy herfclf.

The fomentations, and other remedies before
mentioned, continued to be applied as circum-
fiances required. After the cramp had fiiowed
itfel'f over the whole fyftem in the extraordina-
ry contractions of the mufcles above mention-
ed, the patient frill unable to fwallow, a liberal
ufe of the lifiguentum ceruhum by way of fric-
tion was admitted, from which undoubted ben-
efit was derived ; this fcheme was continued
for a confiderable time. Four weeks have
now elapfed. Some more favorable figns oc-
cur i (lie begins to fwallow a little, but with
great difficulty, and her ftomach is ftill unable
to retain the mildeft fubflance. A faithful trial
of erecl-ricify was made, and advantages far
exceeding our expectations accrued. We be-
gin by exhibiting final 1 mocks, at firft, giving
one or two hundred in a day, we proceeded to
an indefinite number, of hvo, three, or four
hundred, or more : 1 defeating daily the weight
of the (nocks* till <.ve had arrived to a degree,
the* amplication of which to a perfon in health
would hardly be fafe. Bv this fimple re » edy,
the mod obltinate paroxilms were fubje&ed.
A general giving way of the complaint was now
obvious, but all, or moil of 'he fymptoms men-
tioned heretofore, ftill continued with vio-
lence.

lence. The cramp often fixes on the itomach
and other internal parts. On theie occ.afions,
electricity, though fometimes, would not al-
ways procure relief ; our principle dependence
lav, on wrapping the patient up in blankets dipt
in hot water, and applied with as much heat as..
could be fupported.

The Diforder continues to abate. With dif-
ficulty, the patient (wallows a little Laudanum.
Ever-.' opportunity to adminifter relief was
carefullv attended to, and every advantage im-
proved with afliduity. A free ufe of ftimulants
was clearlv indicated. The irritability of the
prima via had conilderably abated ; but for fix
months, though this condition continually gave
wav, the patient ieldom est or drank without
puking, either immediately, or foon after fvval-
lowing. A paufe naturally prefents itielf at this
place : while we reft a few moment*, ibmc obfer-
v ations relative to the treatment may notbeamifs.

In addition to the means above related, I will
rjowmentionthe ufe of Opium, Czmphire, Wine,
Ardent Spirit, Peruvian Park, and a variety of
other iiimulants. Surpriiing quantities of Opi-
um $ were required : the only rule adopted,

was

* The moft approved modern Authors agree in directing a
ous ufe of llna in aluable article for t'ne curti of this tfifi.
*-,r e Says Doct. Culllw when treating on the TETAN-
US, •'erneri'rrcr h«s tacght us that wpntm has ofirn proved
an efFe<£lu.il remedy; tat thai to render it fuch it mull he
riven in mnc'i lirger quantities i' an hav? been employed id
at y othe.cafc." • r^iti, it is thrr r#re prop''r!y obfe»?de\ th;K
in Tecanick aift&ioLs,, as opium fhorvs r.one af tbofa cffcc"h by

which

20

was, to give enough. A common table fpoon-
fnl of Liquid Laudanum was iometimes found
neceffiry : for the only chance of cure lay in
fubjecting the fits. The quantity generally re-
quired, was, from half, to two thirds of a fpoon-
ful, and this, to be given every night for three
months together, and after when neceflary. Pa-
regorick Elixir was more agreeable to the pa-
tient's ftomach than Laudanum ; about half a
fpoonful of this, with an equal quantity of Cam-
phorated fpirit, was given frequently in the

day

which it may endanger life, there is little or no reafon for
being fparing in the exhibition of it : and it may be given,
probably it fhould be given, as largely and as faft as the
fymptoms of the difeafe may feem to demand. ( Culler? s Prac-
tice Vol. 3 Page 298, 299^ Doctor Brown on the fame fubject
fays, •* we muft therefore immediately have rccourfe to the
moll powerful, and molt diffufible itimuli poffible, and contin-
ue their ufe without regard to quantity, not even that of opiur*
it/elf. till the whole tumult of the difeafe is alla\ed." (Ele-
ments*/ Medicine page 34.7) " in order to the cure, opium is
principally to be depended upon." [Motbir&j's Medical Dic-
tionary under Tetanus.) Thefe authorities wou'd fufficientlv
julhf} the free ufe of Opium adopted in the prefect i. fiance,
even though it had proved unfuccefsful : but to an unpxjudi-
ed mind, no other justification would be neceffarv than t 1 at
which mipht be drawn from the effetts produced Af.<r the
patient had been raifed from the dead as it were beyon d the
Hioft dilantvxncAations of every one: after the mod ur.« 1 r.bt-
rd benefit of this moft valu bV ef medicines had fo con'" >cu-
eufly appeared ; xfier the moft fi?nal proof not only of the
efficacy, hut of the absolute receflitv of its ufe h*H rein. 1 d
from the cmfequences of repeated omi.Tions : who v/oul ' think
that any t' rough pr^ju ice, (1 cannot wilh to funpole a wrrfe
ir»o ive) could be led to fay that we "had killed the pirl by
giving her opium" and that if we were t» leave off giving her

Laudanum

21

day time as eircumftances required. With re-
gard to fpirit. gin and wine were mod agreea-
ble to the paeient, and their ule attended with
the moll benefit. Tbrife were the principal in-
ternal remedies, from which any material bene-
fit was derived. Peruvian Bark, Cinnamon,
Galangnl, Snakeroot, and Valerian, were alfo
tried alternately, both in an infuiion in water
and (pint. The Peruvian Bark, though fo
ufeful in lotrie cafes of debility, could not
be depended upon in this ; it was often tried in
the courfe of the complaint, and its omiilion, by
its effects as often indicated. By bracing the
ftomach, diminifhing its fenfibility and averfion
to food, for a day or two, it fometimes feemed
to do good, though the condition of the flom-
ach would not admit of its being received ex-
cept in a fm dl quantity ; but as the crampy dif-
pofition fled from the ftomach, it ufually fixt
upon the urinary paffages, and there produced
an obftinal e JuppreJ/io urinx, the confequences

ot

I "u J arnm " fhe would get r.-M." Doftor Col'en cbfrrves
(Firfl lines page 293 vol. 3) when fpeaking of the Tetanus ;
'• t is difeaie has generally proved fai is indeed may

bejeflly fuppole.1 to be t u e eonfeqocnce of ku nature; but as

we kro'w, th2t, till very lately PhyficianJ were rot well ac-
quainted with a proper method of cure ; zv.v. thai fince ;i more
proper method has been known and practiced, many have re-
covered from this dife fe : it may be therefore concluded that
the fptal ten ency of hi mture is not fo u-. avoidable as has
been imagined " The o'ly reafon that occurs to my mind,
why this diforder has b<en more fuccef- fully treated by prac-
titioners lately, than formerly, is, their !• aving off the evacu-
unr, debilitating pi in of cure, and their adopting an unref-
trained ufc of opium.

22

of which were painful, and fometimes danger-
ous to the patient.

By the firft of May, the patient began to
mend apace. Though the advantages of Elec-
tricity had been fuch, as, to fubje'&the mod ob-
flinatefits of the cramp, alleviate the mod ex-
cruciating pain, and,inoneortwoinftances,appa-
rantly fnatch the exhaufled patient from the
arms of death himfelf ; feemingly, bringing her
back to the world (he inhabits after having pafl
the confines of the other; at this time, this in-
eftimable remedy proved wholly unfuccefsful.
Far from removing a fit, the fmalleft fhock
would produce one. In the montn of June,
the patient had a relapfe, but foon recovered.
To this accident (lie has been fubjecl: periodical-
ly as often as once in four weeks till the day in
which I write ; to the mind of a phyfician, the
caufe will readily prefent itfelf. About the
middle of June the patient's fits left her totally
in the day time unlels brought on by fome acci-
dental occurrence. At evening, the time of the
recurrence of the paroxifms from the firft, they
returned fteadilv till fometime in July. She
now enjoyed a fhort refpite, though a difpofition
to a recurrence of her fits remained, and evi-
dent figns marked the periods. In the months
of Auguft and September fhe was able to ride on
horfeback. The cold bath was twice or three
times exhibited, and proved obvioufly detri-
mental. Lefs quantities of opium than what
were formerly necefTary are now required.

Is

3 J

In October, for a trial, wc omitted the uie of
Laudanum, and the patient immediately began
to decline. We again had recourfe to it and
fhe recovered. The Bark was now given in
fubllance, and was attended with the confe-
quences formerly attached to its uie.

As cold weather advanced, the patient's fits
returned more frequently ' y but continuing to
preferve a lei's irritable ftate of her ftomach,
this circumttance did not cut fhort our expect-
ations of her recovery. Her appetite gained
ground, and, of what (he took down (he retain-
ed a f ufficiency. In November fhe declined faft ;
for nearly a fortnight, her fits return almoft
every night. She has feveral paroxifms of the
Epilepiy. The complaint of the urinary paf-
fages mentioned more than once, is again very
troublefome. She now got better, and in a few
days, appeared as well as before her relapfe.

Dtc ember, flic continues much the fame ;
eats, and drinks more than ihe ever has fince her
i'lncis. She now inclines to the dropfy. Her
fits, which are principally of the Epileptiok
kind, return with more violence : fince the mid-
dle of June, having ceafed in the daytime, they
now came on everv eveninp for eight or nine
days. At this time, having an infatiable thirfr,
which fhe had but too much indulged, (be bloated
extremely : this accounts for the furpriftng
quantity of water fie discharged in foam from
her mouth while the fits were upon her : it is a
curious faft, tha* a quantity of water fufficient
to fwcll the whole fyflcm, was difcharged at the

itith

*4

mouth while fne lay in her fits, and in this way
was ihe freed from the difficulty, and was very
foon as well as me had been before her rekpfe.
Thus, according to a vulvar faying, fhe had her
" uds and downs," the affection of her ftomach
continued gradually to abate, and on no ac-
count was ihe worfe than fhe had been two or
three months before, but the more frequent re-
turn of her fits. How far habit may have had
a hand in producing this eireft I am unable to

In January following nothing very material
took place, except that the hydropick tendency
increafed, which made it neceflfary to exhibit
one or two purges. She now relifhes animal
food. Her fits continue to recur occafionally :
by habit, fhe has a foundation laid for their rea-
dy recurrence, and, happy for her, by the fame
lav/ of the conftitution, fhe is enabled to indure
them with much lefs inconvenience, than any
one from mere obfei vation would have reafon
to believe. For a long time, the patient had
rot been attended with the Catalepfy ; but, the
latter end of this month, this curious fymptom
returned, her fits were (fill frequent, but moder-
ate; tiie paroxifms of the cramp generally ter-
minating in the Epilepfy, which, unlefs remov-
ed by art, held the patient an hour and an half.
When by any means this latter fymptom had
been fuffered to fix upon her (by proper attention
we could often prevent it) the following method
feldom failed of (ubjefting it. The patient,
extended, fenfelefs, and foaming at the mouth,

is

is totally unable to fwallow. I wet her nofe
with Camphorated Ipirit, the fumes of which
were blown up the noilrils with my mouth, then
iprinkled her face with cold water. In a few
minutes (repea'ing this procefs,) the patient
would mow figns of recovery. I then poured
into her mouth a dofe of Laudanum or Parego-
rick Elixir, which (lie would foon fwallow, and
waking up, (he would complain bitterly of her
attendants for waking her.

In February, the girl, having arriven to the
age of eighteen, left the family of my father,
and went to refidc with her mother, a woman
who lived in indigence, and was but illy qua-
lified to afford that affiftance and fupport which
the circumflances of her daughter required.
The voice of humanity followed her, and plead
in her behalf, but here I mutt fay no more.

While the patient continued fteadily to
mend, more efpecially on the latter ptrt of Ju-
ly or the beginning of Auguft, when her fits
had totally left her, though a confiderable de-
gree of indifpofition remained, we were flat-
tered with the hopes of her fpeedy recovery to
a comfortable Mate of health. Should any one
be ready to enquire into the caufes of her unex-
pected dcclenfion, to fuch, the following obfer-
vations, may not be unacceptable. M As cold
weather advanced, the patients fits returned
more frequently." From this, other things
being the fame, one would be apt to confider
the coming on of cold weather as no fmall caufe

C °f

26

of her failure. From the known influence of
genial heat, and the oppofite effects of cold up-
on the {yftem, knowing the condition of the
conftitution on which the diforder depended,
with fome reafon may we draw this inference ;
and the patient's being uniformly better in the
warmeftand pleafanteft days, and her declining
in nnpleafant and uncomfortable feafons, fhow-
ing the great influence of the (rate of the air,
are facts which fcem to juftify the conclufion.
However, we miift reflect, that the patient may
have appeared more infirm than fhe really was.
It is true, her fits returned oftener than former-
ly ; but they continued a fhorter term, and
were much lefs fevere. Much may be owing
to the inftrumentality of habit. On fome ac-
counts, particularly, the ftate of her ftomach,
the patient evidently grew better. As the af-
fection of the ftomach, was a leading fymptom
of the difeafe, high expectations were groun-
ded on its abatement. After all, it cannot be
denied but that the girl grew poorer, and "the
coming on of cold weather" I would mention
as one caufeofher declenfion.

■ Another, and no inconfiderable caufe of her
declenfion, was the exerciie of her mind ; par-
ticularly, a concern relative to her future fup-
port. She was one of thofe unfortunate objects
who are denominated town's poor ; formerly, as
I have faid, had been bound out by the town,
and as her minority had nearly expired, fhe was*
in all probability, foon to fall upon the town

again.

2 7

again. She was fenfible of the great attention
Jhe required. Her mind, like her body, weak
and irritable, was the nuriery ot "fears and ap-
prehenfions. She ufed frequently to fay, that,
*' when her time was ont, (lie was afraid (lie
fhould relapfe and die," and was extremely
grieved to think, " that (he muft go to live fhe
knew not where, among entire ftrangers who
were totally unacquainted with her circumftan-
ces." Thefe, and other objects occasionally Co
agitated her mind as to deprive her of whole
night's reft, and fometimes to fuch a degree as
to produce a delirium. Was it poffible for the
patient to get well under thefe circumftances I
how far it is in the power of the exercife of the
mind, care, grief, anxiety, to debilitate the bo-
dy, thofe bed know who can trace the opera-
tions of the paflions on the conftitution. That
the exercife of her mind, was, not only a caufe,
but a principal caufe of her declenfion, is a po-
fition which I take to be fufFicicntly fupported
by facts. I fhould be happy to fay that her
fears were it foundation.

•She was much pleafed with the idea of living
with, and being nurfed by a parent, and for a
coniiderable time after (he left the family (he re-
cruited apace. Unable to refrrain an infatiable
thirft, which an hydropic!:, diathefis produced,
fhe fell again into the dropfy, which a. tiiistime
proved more troublefome than ever it had done
before, the water accumulating in the thorax
that degree, as, for a number of days, to rendet

it

28

it very difficult for the patient to reft in recum-
bent pofture. A few brifk purges removed the
complaint, but the patient remained weak, and
her fits returned both day and night.

She once more recovered and was able to
walk about the neighborhood, but unfortunate-
ly (he was putting the town to cojl — fome people
have not too mu<h charity— others were for
having her live cheap ; without any medical
afliftance, which fhe knew would be at the
rifque of her life — much talk was raifed. Thefc
particulars would not have been mentioned,
had I not been pofitive of the pernicious influ-
ence they pofleft on the mind and body of the
P'tient. Every thing: tl at affected her difa-
greeably, ferved to keep her down, yea more
to link her, She be gap to fail. Her mother
grew unable to provide for and look after her ;
her former fears, apprehenfions, anxiety of mind
returned, and for a number of clays fre was con-
fined to her bed, and arterded day and night
with fevere paroxifp'S of ike cramp and Epilep-
fy. Fortunately, very curly in the month of
April, fuitahle provifon was made for her fub-
fiitance and comfort, the falutary effects of
which loon followed. Freed from a difagrcea-
ble (late of uncertainty relative to her future
fupport in being under the care of a perfon ev-
ery way qualified to perform the duties of his
charge, her mird became calm — her fears and
arpreheniions difappeared and flic began to re-
cruit,

As

*9

As a traveller in a ftrangc lard, having paft
o'er wild and uncultivated it Ids where never
mortal part before, natui-nlk looks ba< k on the
principal objects, eqr- !Iy new and it liking that
prefented tkemiei\ts on his way, io we, as we
draw near the cortluiion, will now (fop for a
moment to tr.kc a luminary view of the leading
fcenes and fa&s to which v e have been attend-
ing. Let us contemplate in miniature; the out-
lines of the more perfect picture. What do
We fee ? a peHon exert iied with the mod ex-
cruciating: pain ; remaining totally for eighteen
davs, and for fix weeks almoft wholly without
the uie ofdi irk, food, or medicine in a natural
way ; fe\ eral times apparently breathing her
lafl, and rrcre than one frppofed to be dead
for more than a minute : by day, agonizing for
months together, under unheared of fits of the
cramp : b night, lying extended, ftiff, motion-
leis, and foamirg at the mouth beneath the fro-
zen hand of the Fpilepfy : rackt with convul-
sions; twifted and bent into all poffible Pnapes
andpofrures : crampt backward and forward in
an unheard of degree for twelve, and even
eighteen times in. a day : now gaming her tongue
between her teeth, now raving with madnefs
ard attempting to take away her life. How
gratifying mud it be to the author of this ac-
count to be able to fay, and how pleafmg to ev-
ery feeling mind to hear, that the (object who
ir.dured all this, furvives, and enjoys a profpect
of recovery to a comfortable (late of cxiflencc.

Much

Much is expedled from the return of warm wea-
ther ; the influence of which, even now (April
20th) appears to be confiderable. Much, alfo,
will depend on the attention and tendernefs of
one, who, not through any motive of intereft,
has become obligated to provide for and fup-
port her.

FINIS.

<Ti

Book taken apart, leaves d eaoidified

with magnesium bicarbonate* Leaves

mended, title page supported on both

sides -with lens tissue. Reseved with

new all-rag end paper signatures &

unbleached linen hinges* Rebound In

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sides* February 1976*

Carolyn Horton A Asboo*
1+30 West 22 Street
New Y ork, N.Y* 10011

(jOZ

HORTON BiNDERY