154 ANNUAL REPORT OF THE OfC. Doc. 



lowed during the present year by a severe burn of the right arm and forearm. 

 The patient was just recovering from the latter condition when, upon attempt- 

 ing to caress a strange dog, he was bitten in the palm of the left hand, in the 

 web between the first two fingers. 



The wound was thus inflicted August 23, 1903. It bled freely at the time and 

 was cauterized one hour later with a solution of silver nitrate (of questionable 

 strength), followed by pure carbolic acid, and an antiseptic dressing applied. 

 The wound healed kindly without any decided complications. 



Premonitory Sln^e .—In the evening of October 1, 1903, just 39 days after 

 infliction of the wound, the patient's attention was attracted to his left hand 

 by a tingling sensation in the tips of the fingers and in the cicatrix. His wife 

 states that during the following two days he appeared greatly depressed, 

 restless at night, had little or no appetite, and complained of a constantly in- 

 creasing aching sensation in the left hand and arm. 



Spasmodic Stage. — Upon arising from bed in the morning of October 4 the 

 patient complained most decidedly of the left hand, arm and shoulder, and 

 of a pronounced feeling of debility. He went to breakfast, however, as usual, 

 and upon attempting to swallow the liquid it was suddenly and involuntarily 

 expelled from his mouth. He then went upstairs without assistance and lay 

 upon a couch, complaining at the time of feeling extremely weak. 



At 10 o'clock A. M. I was asked to attend the patient, and found him decidedly 

 restless, and complaining, in addition to the aching arm and shoulder, of 

 being very chilly. The skin was moist, the muscles relaxed, reflexes normal, 

 and face flushed. Pressure along the nerve trunks and muscles of the left arm 

 and shoulder was slightly painful, but did not seem to be productive of any 

 local or general spasm. Attempts at prolonged conversation, however, seemed 

 to cause, from time to time, a sudden involuntary laryngeal spasm, after 

 which the patient would be unable to resume talking immediately because of 

 a marked dyspnea thus produced. The temperature at this time was 101 degrees 

 F. , the pulse 102; and the respirations were 24. 



Upon receiving the history of the patient's inability to swallow water while 

 at breakfast, I decided to prescribe an antirheumatic in powder form to be 

 taken with water during my absence, in order to avoid arousing the patient's 

 suspicions regarding my belief in his ability to swallow liquids as usual. 



At 3 o'clock in the afternoon I was informed that after a great effort he 

 had swallowed one pftwder, but that a repetition had been absolutely impos- 

 sible, and, furthermore, that had refused all liquids and solids at lunch time. 

 There was now a pain on the left side of the neck which seemed to be most 

 marked along the posterior borders of the trapezius and sternomastoid muscles, 

 radiating toward the occipital portion of the skull. 



The patient complained of an almost constant smothering sensation in the 

 larynx, and the slightest efforts to talk would now very readily provoke a 

 laryngeal contraction, during which time the patient continually held his 

 hand to his throat in an effort to relieve his dyspnea and was extremely rest- 

 less. The temperature continued to. be 101 degrees F., the pulse was 98, and 

 respirations 26. 



Feeling that future treatment of the patient depended upon an absolute 

 surety as to the diagnosis, I asked Dr. Samuel Wolfe to see the patient, and 

 after a verjj careful examination and consideration of the deflnite history Dr. 

 Wolfe came to the conclusion that the case wa.s almost certainly one of true 

 hydrophobia. The actual state of affairs was at once explained to the family, 

 and thus all obstacles to future treatment eliminated. 



At 6 o'clock the same evening (10 hours after the first appearance of active 

 symptoms) it became necessary to resort to hypnotics to control the spasms, 



