last night at 12 o'clock, and again this morning at 8.25' having on these two occasions complained of pain in dorsal region, with slight spasms, probably the result of over-exertion or fatigue, as he has been out of bed daily since the 3rd, and on the 6th sat up all day and exerted himself more than he had done. Is at present free from pain. Slight bending forward of dorsal vertebræ is visible when he sits or stands. Walks with a stiffness at hip and ankle-joint, but able to go out of doors to-day, leaning on an arm. Tongue clean. Pulse 72. Bowels regular; stool natural. Belly fuller. 13th.-Is now quite well.

2.-ADDITIONAL CASE OF TETANUS, WITH REMARKS;

By DR E. WATSON, Professor of Physiology, Anderson's University, and Surgeon to the Royal Infirmary, Glasgow.

On the 26th of June, 1868, I was asked by Dr Fergus to see a patient of his who was affected with tetanus. I found that the disease had been coming on for some days, and that its cause was very obscure. The patient was a young man, twenty years of age, who had for some time been annoyed with a papular eruption on the skin of the arm, for which he had been treated by a chemist in town, without applying to his medical attendant. I therefore inquired of this chemist what drugs had been used by him, but found that they were sufficiently safe and simple. Some of the papules were suppurating when I looked at them. The patient had also received a slight cut with a piece of copper on the same arm, but the wound was quite healed.

When I visited the patient his back and extremities were very rigid, and he was taking frequent fits of opisthotonos, but his face was less affected than usual, and he could swallow well. I therefore commenced the treatment with good hope of the

result.

At first he took the tincture of the bean made by percolation, but as soon as possible it was changed for the following tincture, in using which one can be more precise as to the doses administered:

The extract is dissolved in the water at a boiling temperature, and the spirit is gradually added. The fluid is then filtered, when a clear sherry-coloured tincture is obtained. I have kept this tincture for three months without any turbidity or other change taking place in it, and I believe that it is sufficiently stable for all practical purposes. Every ten minims contain one-twelfth part of a grain of the extract, which is a good dose to begin with in an adult.

Such a dose was given every hour at first, with the effect of greatly relaxing the stiffened muscles of the back and extremities. His bowels were likewise freely moved on the 26th, by a dose of castor oil, with a drop of croton oil mixed with it. He had short sleeps during the night, but next morning the spasms could still be excited, though neither so readily nor so severely as formerly.

During the first part of the 27th he had his doses of the tincture every half hour, and felt so much the better of each dose that he constantly asked for them himself, and would have taken them even oftener. By mid-day his body was more relaxed than ever, so that he could move himself in bed, and raise his head from the pillow. I therefore left him in the care of Dr Fergus, with particular instructions how to proceed. These were carefully carried out by him, and the case went on most favourably. The patient's hopes were completely restored, and he spoke of soon being at business again. The administration of the bean was continued every two hours during the night, and in the morning (28th) Dr Fergus found that it had considerably affected his patient with its depressing action. In fact, the patient fell into a syncope when Dr Fergus was present, but by admitting fresh air and rubbing the chest he recovered and seemed much improved. Unfortunately, however, after Dr Fergus had left, he again fell into a similar state,

* This should be done in a covered vessel, as the steam, if allowed to escape, would carry off much of the active element of the bean.

and as there was some loose mucus in the throat his friends turned him round to allow it to fall out; on their doing this, he was seized with a violent and universal paroxysm, in which he died about ten a.m.

On returning to Glasgow, which I did on the following morning, I was greatly mortified at learning the result of this case. It is the first and only fatal case which has occurred to myself in which the bean has been fairly tried. I did regret that the patient had been perhaps roughly, because hurriedly, turned round upon his face, for no doubt that was the exciting cause of the fatal convulsion. Had the milder, and sufficiently effective means, adopted by Dr Fergus, been again employed, I think the issue might have been different. But whether this be so or not, I think we may learn from this case the following lessons:

1. That in the most violent cases of tetanus the bean may be so administered as to diminish the force and duration of the convulsions.

2. That the bean does not rapidly counteract, far less change, the morbid lesion in which the proximate cause of tetanus consists. In the preceding case the spasms were greatly mitigated, and yet the disease still existed, in a latent state no doubt, but yet capable of being roused into great and even fatal activity.

3. That it is, therefore, of great importance to commence the use of the bean early in all cases of tetanus, so as to give it time to act before the disease has become matured. In the preceding case the disease had reached its greatest violence before the medicine was begun at all.

4. That in the state of depression, which is one of the physiological effects of the bean, the patient can very ill bear the renewal of the convulsions. The case is an example of this, and I have often witnessed the same thing in my experiments on the lower animals with strychnia and Calabar bean. The gentlest means for restoring the feeble respiration of the patient when so affected, should alone be employed, and the mouth or throat should be cleared by means of the finger, or by any suitable substitute for it that comes first to hand.

The cases of tetanus treated by the Calabar bean, as I have recommended it, now amount to the following numbers:

These were all acute traumatic cases of tetanus, some of them very severe, and all of them warranting the most unfavourable prognosis. Indeed I believe that a similarly good result could not be shown in such cases by any other kind of treatment. It ought to be remarked, likewise, that one of my fatal cases (Lancet, 1868) was really not treated at all, as the man was dying when I saw him, and he only doubtfully swallowed one dose of the remedy.

I have now the pleasure of appending to this paper the first case of strychnia poisoning in the human subject treated, and treated successfully, with Calabar bean. It was given at first in the form of a letter to me from the gentleman who attended the case, and I think it best to publish it now in the same form, for which I have the author's permission.

3.-CASE OF STRYCHNIA POISONING.

By JOHN W. KEYWORTH, M.D., M.R.C.S.

BIRMINGHAM, April 13, 1868.

DEAR SIR,-I have read with much interest the account given by you in the Lancet of the treatment of tetanus with Calabar bean, and as I was thence led to employ it successfully in a case of poisoning by strychnia, it may possibly gratify you to receive a brief sketch of the particulars, especially as your remarks in the conclusion of your paper in last week's Lancet a little contradict my experience. On the 23rd of July, 1867, at 7 a.m., I was sent for to a female patient of slight suicidal tendency, who had taken, at 11 o'clock the night before, a packet of Battle's Vermin Killer (containing, it is stated, 3 grs. of strychnia). The body and limbs were perfectly rigid with spasm, which, when occasionally relaxed,

was excited by merely blowing in her face, or by the shaking of the floor in walking. She had been in this condition since 2 a.m., gradually becoming worse. She was speechless, but conscious, and her pulse very rapid and feeble. Her face was livid. The jaws were constantly fixed. Having recently read your paper, and seeing also that the case was almost hopeless, I sent up to the Eye Infirmary for some of the wafers. Failing there, I obtained from Messrs Southall of this town, pharmaceutists of the first order, some tincture of Calabar bean. They could not give me any information as to the dose. I gave 30 drops every half hour till two drachms had been taken, pouring it into the mouth where a tooth was absent. The effort of swallowing produced violent spasm. After each dose the attack grew less frequent and strong, and I then gave two half drachms at intervals of an hour, then 15 drops every two hours. Altogether half an ounce was taken. The pulse then became extremely weak, the spasms almost ceased, but the woman could scarcely speak or swallow. At the end of some hours she remained very feeble, quiet, but sleepless, and her legs and arms "felt like lead," and were utterly immovable. This gradually subsided, but she could not stand or walk for four or five days, and was three weeks before she fully recovered. The poison was taken in gin, and appeared, from the inspection of the cup, to have been wholly taken. An hour and a half afterwards she appeared, her friends said, "to be in a fit," and shortly afterwards became "convulsed." The effect of the Calabar bean in relaxing the spasms was apparent in about twenty minutes after taking the first dose, and became more apparent and decided after each repetition.

This is the only case in which I have as yet had an opportunity of trying the antidote, and of course it proves little; but I shall certainly be disposed to repeat it in any analogous case. The instance was favourable, inasmuch as from the time the poison had been taken, and the condition of the patient, emetics and the stomach-pump were out of the question. And as strychnia appears to destroy life chiefly, if not entirely, by its action on the muscles, there would seem every reason why with it, as well as tetanus, this antidote should be effectual.