and frightened, but still asserted that it was nothing to do with the bite."

The day on which the hospital record begins is January 21, 1876, which, in the absence of anything to show the contrary, may be taken as the day of admission. "Patient sitting up in bed, face slightly flushed, but this appears to be the normal condition. There is an anxious expression, not a careworn look, but one rather of fright, or anxiety on account of some impending danger, and the general behaviour of patient is such as to lead one to think that he takes a 'fearful' interest in surrounding objects. When people come into the ward, patient quickly catches their footfall, and looks fixedly at them. His attention is arrested by slight objects, and he appears to rivet it on objects and actions which would remain unnoticed by others. Every few minutes, gives a sigh, not ordinary sigh of relief, but consisting of sudden, quick, respiratory act; does this when spoken to quickly, or when slight draught arises from window, &c. Displays difficulty in getting words out and on beginning to talk, and, when speaking, keeps up a rapid tapping at the chest with right hand, because, as he says, 'speaking seems to hurt me, as if there was something gnawing me there.' 6.30 p.m.-Patient taken no food; on two occasions, he put ice into his mouth, and apparently swallowed the water with great difficulty, expressing himself on each occasion as relieved. From 3 to 4.30, had been quite quiet, talking easily to visitors. After this, repeated spasmodic movements supervened, which came on suddenly, causing him to jump up and roll himself. forward or double himself up, at the same time violently rubbing epigastric region, shout for help, and then, in a few seconds, would lie down quite easy, repeating frequently, 'There, now I am better.' At other times, he would throw his arms out, keeping them rigidly extended and hands tightly clenched. Morphia given, hypodermically, and in five minutes great relief. Every now and then, takes deep inspirations, and then lets out the air by repeated

short expiratory acts. Pupils acting (to light) equally dilated. Heart acting regularly. Respirations very irregular. p.m.-Effects of morphia wearing off; a few spasms, in one of which he started from lying on his back, ground his teeth, beat the bed with arms, turned over, and buried his face in pillow, struggling with the attendants. Nearly every muscle seemed affected; legs became as hard as wood. Dr. recommended chloroform to be given, to render patient sufficiently unconscious to allow of passage of food into stomach, either by short tube or stomach pump; and afterward morphia, to induce sleep. If spasm of glottis and consequent asphyxia (the immediate cause of death), he would perform tracheotomy. No benefit from ice to spine. In Dr. —'s opinion, food must be given somehow, as, exhaustion becoming greater, the spasms would increase. 10 p.m.-Patient placed in padded room, and strait jacket put on. The moment vapour of chloroform came near him, the sensation of choking came on with terrible violence and great lividity. As each inhalation produced such violent symptoms, it was discontinued. Morphia given, and patient left for the night.

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22nd January, 5.30 a.m.-Medical officer called to see patient. From 11 last night to 4 a.m., patient slept quietly and continuously; on awaking, he expressed a wish for port wine, and asked for water; on seeing the latter, the spasms were very frequent and violent; had an extremely wild look between attacks; eyes very prominent, and

.

pupils dilated; profuse sweat; breathing heavily; slight tremor in extremities. Morphia again given, and water injected cold, as enema, to allay thirst, repeated hourly. 9 a.m.-Medical officer again called to witness the most severe spasms it is possible to conceive; every distortion of attitude was quickly gone through in succession; loud shouts of Murder,' &c.; morphia evidently losing its effect, but patient craved for its repetition, even though it gave only a few moments' relief. 10 a.m.-Patient very violent, and for the first time there were well marked delusions.

(It is not necessary to give these details.)

"The same fright

ened look. Movements now seemed not so much the result of involuntary spasms as of premeditated design. (Attempts to injure the attendants are here described.) "Two porters cannot now hold him. Countenance

fearful; struggling as if for life; after this, sank down much exhausted; a momentary glance at a rotating ventilator set up most violent spasms. Becoming much weaker. Once or twice, the air escaping from lungs burst open the glottis, with a short, sharp ring, soon becoming like bark of dog, and his movements, &c., appeared crouching, and generally simulating those of a dog. 3.30 p.m.-Patient died. "During his illness, he often remarked not mad-No more mad than I am.' of the two days, he did not appear to swallow his saliva, but spat a great deal of frothy matter."

that the dog was During the whole

The patient was probably right. There was no evidence that the dog was rabid. Soon after the accident, he summoned the owner before a magistrate in London, on the ground that he allowed a ferocious dog to be at large. On hearing the man's account of the accident, and evidence of the quiet character of the dog, the magistrate decided that, merely because the man had accidentally trodden on the dog, and had been bitten, it was no proof that it was a dangerous animal, and refused to make an order for its destruction.

Any remarks I might make on examples of this and the former are rendered unnecessary by the subjoined paragraph from the Lancet :

"The fallacies attending a diagnosis of hydrophobia are strikingly illustrated by a case which occurred, a few days ago, at Leamington. An inquest was held on the body of a woman, aged forty-six, who was popularly supposed to have died in consequence of hydrophobia, caused by the bite of a cat. A month after receiving the bite, a convulsive attack ushered in a period of restlessness and nervousness, during

which the bite was evidently foremost in her mind. These symptoms lasted ten days, and suggested to the medical men in attendance the probability, and to the friends of the deceased the certainty, of hydrophobia. Its distinctive symptoms, however, were absent; and on the eleventh day, an attack of epileptiform convulsion occurred, followed by hemiplegia, coma, and death. A certificate of apoplexy and hemiplegia was properly given, but the popular supposition of hydrophobia led to an inquest. This was adjourned, in order that a post-mortem examination might be made, which showed meningeal hæmorrhage and granular contracted kidneys-conditions amply sufficient to account for the whole of the symptoms. The case itself is instructive. Bites from dogs and cats are very common; cerebral diseases leading to general symptoms are not very rare. The concurrence of the two incidents generally leads to the inference that the bite is the cause of the symptoms; and when, in addition, a state of nervousness and rabiophobia is present, the symptoms are rendered complex, and the diagnosis a matter of some difficulty."

There is, however, something more than a possibility—since spontaneous recovery from rabies is known to take place in both man and animals-that animals suffering from a mild attack may inflict wounds which communicate the disease in a fatal form, while they themselves recover, not having exhibited such marked symptoms as would lead to the conclusion that the disease was present in them.

With respect to the treatment of the bite from a suspected dog or cat, or even one that is not suspected, it must, in the present condition of knowledge, or rather ignorance, be simply local. Dr. George Fleming, F.R.C.V.S., in his excellent work on "Rabies and Hydrophobia," recommends: A. Suction* by the mouth, carried on persistently and energetically for some time, spitting out very frequently, and, if possible, rinsing the mouth with water, &c. B. Expression, or squeez

* See next page.

Treatment of the Bite.

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ing the wound, in conjunction with the above. C. Washing with cold or tepid water, poured from a vessel held at some distance from the wound. F. Cauterisation, when immediate, is at once the promptest and safest treatment. The best instrument is a piece of iron heated to a white heat, in shape pointed, round, or the figure of an olive. Iron instruments of a suitable shape are at hand in every dwelling, and, while being heated, suction, washing, and compression (above the wound) should be resorted to. Gunpowder, a fusee, or a lucifer match, may be ignited in the wound when the iron is not immediately accessible. G. Caustics, solid or fluid, may be employed, with the same success, or they may be preferable or supplementary to the actual cautery. H. Excision and scarification should be practised when necessary, though they demand more skill.

Suction is recommended, in medical works, in the case of snake poison, but I believe it to be by no means safe, in view of the ready absorption of that virus by the mucous membrane. Few mouths are free from slight abrasions, decayed teeth, or spongy gums (emitting blood on suction), and it may be a grave question whether the virus of rabies might not enter the circulation if this plan is resorted to by someone else than the sufferer; though, perhaps, the latter would not be further imperilled by sucking the wound himself; and he is undoubtedly under a moral obligation to take any risk on himself, if he can reach the wound, rather than allow another to incur it. Actual cauterisation, caustics, excision, and scarification, should not be entrusted to any but skilled hands. A ready mode of treatment by the general public is suggested by Dr. Fleming, when medical aid cannot be obtained. After cleaning the wound, by washing and compression, pour black ink-the coloured inks may contain injurious chemicals-into the wound, and wash out the stain and repeat the process. The object of this is to insure thorough cleansing. The same treatment as that recommended by Dr. Fleming, excision, cauterisation, &c., may be