No. 6. DEPARTMENT OF AGRICULTURE. 155 



which were now becoming very much longer in duration and more decided in 

 severity. Eight mg. (% gr.) of morphin and .4 mg. (1-150 gr.) of atropin were 

 accordingly given hypodermically with a very beneficial result, enabling the 

 patient to obtain a much needed rest of 4 or 5 hours' duration. 



It became necessary to repeat this injection 6 hours later, at which time 

 there was a noticeable hyperesthesia of the left side, especially marked at the 

 time of puncture with the hypodermic needle. The patient's general appear- 

 ance was now that of a decidedly sick man and one whose suffering was any- 

 thing but of an hysteric nature, his manifest desire to assist with his treatment 

 and avoid worrying his family being most pronounced. 



The second administration of morphin and atropin had only been beneficial 

 so far as respiration was concerned, the injection being repeated at 5.30 A. M. 

 (5V2 hours after the second administration) with better results, especially 

 the severitj' of the laryngeal spasms, but with no decided effect upon the fre- 

 quency of recurrence. 



All attempts to have the patient take food of any variety by the mouth 

 failed, and nutrient enemas (of beef) were resorted to and retained, being 

 given, always after a hypodermic injection of the narcotic. 



In the afternoon of the second day of the spasmodic stage, Drs. M. P. Ravenel 

 and D. J. McCarthy were called in consultation and made a careful examina- 

 tion of the patient, especially as regarded the nervous symptoms, and stated 

 that in their opinion the case was undoubtedly one of hydrophobia. 



There seemed to be a slight tendency to increased salivation during the past 

 6 hours, and now, regardless of the atropin that had been given, there was a 

 moderately abnormal flow of saliva, probably caused, to a certain extent, by 

 the almost continual movement of the patient's jaws and tongue. 



With the approach of evening the general condition became gradually worse, 

 and at 8.30 P. M. a series of spasms developed, extending over a period of 30 

 minutes. During this series of paroxysms there was increased sanivation, in- 

 tense dyspnea, rolling of the eyes, continual change of position, marked 

 eructions of gas, and the passage at this time of about 6 ounces of urine, 

 making 10 ounces passed within 5 hours. Delirious symptoms now became 

 noticeable, but occurred only at intervals of 2 to 3 hours, and were of very 

 short duration. 



During the course of the next 10 hours but 2 administrations of morphin 

 were necessary, the patient resting fairly quiet until Tuesday morning (October 

 6, the third day of the spasmodic stage), at which time control of the patient 

 became a difficult matter. The excitement became maniacal, and it was feared 

 the patient would do himself personal injury, although his entire appearance 

 was at times one of terrible fear, and he would hold his throat with both hands 

 in a frantic effort to relieve his dyspnea. Attempted inhalations of chloroform 

 at this time and other times gave no relief, and only seemed to increase the 

 suffering. 



After some effort .6 mg. (1-100 gr.) of hyoscin hydrobromate was given hypo- 

 dermically with a very gratifying effect. This dose of hyoscin was repeated 3 

 hours later, and was the last administration of a hypnotic of any kind that 

 was necessary during the remaining course of the disease. The temperature 

 was now 101.6 degrees F. , the pulse 124, and respirations 44. 



ParaJjjtic Stage. — A few hours later a gentleman who saw the patient pro- 

 nounced the case one of hysteria of a remarkable type, and was so positive as 

 to his diagnosis that it was decided to put the patient upon hysteric treatment. 

 Accordingly, all medicinal administrations, rectal feedings, etc., were discon- 

 tinued, and no .one except the nurse or a substitute allowed in or near the room. 

 Twenty minims of sterile water was given hypodermically every 2 or 3 hours. 



