Note on a Case of Tetanus After the Induction of Premature Labour.

Abstract

903hurry he neglectei to retard the spark, and taking a tight hold of the handle he gave it a sudden pull, when, instead of starting, the engine fired back and he received a violent shock on the hypothenar eminence. As an interested crowd was now collecting the injury was not taken much notice of and the driver, retarding the spark, quickly restarted the engine and proceeded on his way.When I first saw him, which, as already stated, was ten days after the accident, there was a prominent swelling over the proximal half of the fifth metacarpal bone of the right hand, and on manipulating the bone I expressed the opinion that it was fractured.In order to decide the diagnosis, I next day sent the patient to have a skiagram taken and the fifth metacarpal bone was seen to be fractured at the point of junction of its base and shaft. The picture was not so clear as it would have been had the hand been radiographed immediately after the accident as there was a large amount of temporary and partially impervious callus showing. The patient made an uneventful recovery.Several cases of fracture of the lower end of the radius have been recorded as the result of firing back of motor-car engines when attempts have been made to start them whilst the spark was advanced but I have seen no case recorded in which a fracture of any other bone occurred during this manipulation. The fact that in this case it was the fifth metacarpal bone which gave way is sufficiently accounted for when the conditions under which the accident occurred and the various factors at work are considered. First, I in the hurry, a tight and strong grip was taken ot the starting lever, the driver's hand being passed so far round the handle that its olivary end rested on the hypothenar eminence; and secondly, the spark was so far advanced that any back-fire occurring was sure to be a sharp one and such as would allow no time for the release of the handle. The quick recoil was therefore transmitted most forcibly through the most prominent part of the handlenamely, its olivary end-which was resting directly over the portion of bone fractured. Had a less tight grip of the handle been taken the principal effort required to start the engine would have been exerted by the thumb and index finger and therefore when the back-fire occurred one of two things might have happened-viz., either the hand:e would have flown from the grasp altogether or the force wou'd have been transmitted through the first and second metacarpal bones to the lower end of the radius, resulting in a fracture of that bone.