A second case of the same disease came into my hands on same Sunday:

J. Q., a Swede, æt. 22, a sign painter by trade, had been in bed five days when I saw him. Polyarthritis obtained on right side, the ankle and wrist-joints and the joints of the phalanges of hand and foot being very painful, stiff and tumefied. Patient constipated, with acid urine and moderate pyrexia. Purgation by 5 gr. hydrarg. submur., pulv. jalap aa grs. xxx, and free vesication, as in former case in three days effected patients recovery. It is not desirable to combine the alkaline treatment with vesication, as the systemic neutralization of the poison interferes with the local action of the blisters, but the lithium bromide as I used it did not retard the effect of the cantharides, nor protract the period of the patient's convalescence.

The method of treating inflammatory rheu matism is after the French physician, De Chilly and Dr. Herbert Davies, and I earnestly recommend it to those who have not tried it. The blisters were so applied as to nearly envelop each affected joint, and the readiness with which they relieved the pain was of surpassing satisfaction to both physician and patient. Where there is a disposition to strangury as a result of the specific energy of cantharides, the area of vesication can, of course, be limited to suit the exigencies of the case.

From the fact that the vesication directly abstracts the materies morbi from the system, I am convinced that it reduces the danger of cardiac trouble to a minimum.

I shall certainly, in my own practice, give this the precedence of any other known treat

wolves, and foxes. I have known a skunk to communicate a fatal bite. The disease may be traced to very remote antiquity. Pliny, who was contemporary with the beginning of our era, wrote of it. It has been called hydrophobia, canine madness, and rabies.

The cause of the development of rabies is unknown. Among conditions thought to favor its development by different authors, are the following:

1. Extreme heat or cold; especially the first; but it is doubtful if it has any great influence. Dr. Mosley, who practiced many years in the West Indies, says, "That during his residence there he never heard of the disease, and from inquiries which he made, he is certain there had been no rabies in many of the islands for fifty years before 1783. In many hot countries the disease has never been known to prevail. Though Turkey is infested with dogs, rabies is rare in the northern parts of the empire, more so in the southern, and is unknown under the burning sun of Egypt. The disease is favored by a condition of debility and this may be induced by either heat or cold.

2. Putrid food has been thought by some to cause it, but there is no good reason to think this is true. No known facts indicate that it invades the system through the digestive organs.

3. Lack of perspiration some have thought a cause.

4. Worm under the tongue. Of this Morgagni the anatomist, says it is a spiral substance between a ligament and a tendon. This was often removed from dogs by operation as a preventive measure. Dr. Hamilton who wrote a laborious treatise on rabies, in two volumes, says in relation to the time that elapses between the bite and the development of the disease, that ten days is the shortest authentic period, and nineteen months is the longest, the disease showing itself in the greater number from the thirtieth to to the sixtieth day, and next from the sixtieth to the ninetieth. These conclusions are based on reports of 131 cases; of this number seventeen were seized before the thirtieth day. The

period seems to depend on the nervous sensibility of the person. Women and children. develop the disease sooner than men. The duration of the disease varies but little. Few die before the third day, and few survive the seventh, the average being four or five days. The disease is influenced by mental impressions, as when the patient fears that the dog which inflicts the wound has rabies. It would seem that the bite of a rabid animal does not usually communicate the disease, if we are to accept the statements of numerous writers of well established credibility. Dr. Mease says, "a large proportion of persons bitten by dogs actually mad, are never affected by the disease, even though they dispense with preventive remedies." Cocchi says, "that among several persons bitten at the same time, some died notwithstanding the most noted methods of cure had been used; and that others again remained perfectly well, although they underwent no manner of treatment."

Dr. Vaughn says, "that between twenty and thirty persons, were bitten by the dog which gave the fatal wound to the boy whose case he relates, and not one felt the least ill effects except himself." Mr. John Hunter declares from his own knowledge that there were twenty-one persons bitten by the same dog, nothing was done for any of them, and only one was taken ill." Dr. Houlston relates a case where only one out of nine bitten received the infection. From these examples the writer continues. "This affords occasion for the administration of empirical remedies; a favorate nostrum which is said never to have failed, is exhibited, the patient happily survives and escapes an attack of the hydrophobia; the remedy is of course extolled, and its reputation established; whereas, on strict inquiry, it is found undeserving of the least consideration. It is from similar occurrences, that numerous pretended rem edies are imposed upon the credulity of mankind, and which with their authors acquire unmerited reputation. Dogs and other animals are vastly more susceptible to the infection than the human species. The wound

usually heals without trouble, but sometimes an ulcer is formed. On the approach of the disease the cicatrix becomes elevated and hard, with a sense of itching and pricking. Among the symptoms are lassitude, cerebral pain, the patient is forgetful and drowsy, is irritable, has disturbed, sleep, eyes watery, salivation, delirium, is sensitive to light and noise, has constriction of the throat, and difficulty of swallowing, especially of liquids.

Rush, Cullen, John Redman, Coxe and others say, that these symptoms sometimes attend hysteria and tetanus, yellow and typhus fevers.

Treatment and Prevention.-The best prevention is to avoid the bite, or cleanse the wound. No treatment is known to be curative, though many methods have been tried.

Snake Stone or Mad Stone.-Of one of these Dr. Mease of Virginia gives the following account. "It was rather more than an inch long, about five-sixteenths of an inch broad, flat and of a bluish slate color. Its owner offered to dispose of it for $2,000 in shares of $10 each. Such was the avidity with which this rare opportunity was embraced, that the proposed number of shares was filled up in a few weeks by the inhabitants of four or five adjacent counties, and at a meeting of the stockholders for the purpose, the precious catholicon was deposited in the hands of Dr. Brockenbrough, as a central spot whence it. might be readily obtained on every alarming occasion. No person presumes to call in question the reputed attributes of this great specific which sets at equal defiance the venom of rattlesnakes and the slaver of mad dogs."

This stone was supposed to attract the venom from every part of the system to its own pores when it would drop off, when being carefully washed in lime water and milk it could be applied again with equal efficacy. The stones were said to be obtained from India.

Tracheotomy has been recommended to relieve the attendant dysphagia and dyspnea. I do not know that it has ever been resorted to for this purpose, but it would seem to promise temporary relief.

HYDROPHOBIA MAY BE MISTAKEN FOR

TETANUS OR HYSTERIA.

The poison of hydrophobia, whatever may be its nature, begins its activities, so far as the nervous system is concerned, in the medulla oblongata, and that of tetanus in the same structure, the one selecting the nucleus of the pneumogastric and the other that of the trifacial. It is not unreasonable, therefore, that they should closely resemble each other in their earlier history.

There being such a widespread fear of hy drophobia, it is not unreasonable that the hysteric person should, from time to time, be overwhelmed by this emotion and manifest symptoms allied to the disease.

The following table modified from Poland shows the important points of differentiation between tetanus and hydrophobia:

mediately upon the bite, within a day or two. The hysteric patient is loud in expressions of apprehensions, while in hydrophobia there is no such demonstration.

A few days' delay will make the diagnosis certain, because hydrophobia is usually fatal in four days.

In hydrophobia, as the end approaches, there is a rise of temperature, speedily rising to 105° at least.

In hysteria there must be found the other evidences of the condition such as the history of previous attacks—the hysterical, left side anesthesia, ovarian tenderness, epigastric tenderness, mammary tenderness, facial anesthesia and blinking of the upper eyelids. TREATMENг.

the immediate cure of the wound. Every effort should be made to extract the poison by cupping and sucking.

The first consideration under this head is

The tissue invaded should be destroyed in an unsparing manner, with actual cautery, with nitric acid or with lunar caustic. The wounds should be kept open by unguent vaseline, and when later along the wound changes its appearance, or when it becomes the seat of unusual sensi

bilities, the cicatrix must be opened without delay and suppuration be induced.

In considering the value of the prophylactic measures, it must be remembered that only one person in every four of those exposed to the poison develops the disease.

No antidote has yet been found for the rabitic poison. The great expectations raised by M. Pasteur's method are now about dispelled by the death of several of his alleged

cures.

The probability is that the reported cures by the various plans of treatment were either mistaken diagnoses or spontaneous recoveries. Recovery has followed the use of hoang-nanhot air baths, pure air injection of a drop of chloral and the galvanic term by the method of general galvanization.

Quinine and alcohol are the remedies that,

of the insane.

"Technics,, quoting from Progrés Medical, gives a correspondence from Dr. C. MacDowell of Bombay, physician in the British army of East India, who speaks with great enthusiasm of the treatment of dysentery by ipecacuanha. Like other friends of this treatment, such as Docker, Ewart, Cunningham, Malun, etc., he says that it is almost a specific, renders the disease easy to cure, and prevents the complication most feared, i. e., hepatic suppuration. But he emphasizes, particularly "that the remedy be given early in the disease, at the proper time and in the proper manner." The principles of the treatment are:

1. To give a large dose of ipecac, at least 30 grains, for an adult.

2. To prepare the stomach to accept and retain such a large dose by about twenty drops of laudanum an hour before giving the ipe cac; also the application of a sinapism over the stomach; and to administer the ipecac in the form of large pills, not in a solution. It must also be given at night, at the time of going to sleep, never in the morning, and not during the day, and no liquid is to be taken after the dose has been given.

Sometimes the patient vomits a little mucus towards the morning hours, but the greater portion of the remedy has by that