Skip to main content

Full text of "An account of a remarkable case of the tetanus"

See other formats


Bethesda, Maryland 

*. N 





tid by Thomas Hun' 



•$•& I <8( I "0. i 0. j 

^^^««v<fet»»»«K'' , » , 'Bi* >, ''^S , '»"« , fei > '*^»*y^ J '»'Iji'» < '"*»^t > 

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, 
Lebanon^ April t 22, 1794. 


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, 


of a remarkable cafe of the 


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. 


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 


% 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 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 


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 '■' 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. , 


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 



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 

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 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- 


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 

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 


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. 


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- 


|| 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- 



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, 


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 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. 


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, 
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. 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, 


* 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<£ 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 af tbofa cffcc"h by 



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 


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 
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 



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 


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. 


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. 


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 



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 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 


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 


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 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- 



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 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. 



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 

quarter linen with Pabriano paper f\ !>*?£)< 

sides* February 1976* 

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