156 ANNUAL REPORT OF THE Off. Doc. 



and the nurse informed me that there was absolutely no effect as to the fre- 

 quency of the spasms, but there seemed to be a steady decrease in the severity 

 regardless of the time at which the injections of water were given. In other 

 words, it was very apparent that regardless of treatment the patient was 

 slowly passing into the paralytic stage of hydrophobia. 



The patient now began to perspire profusely, and vomited for the first time 

 about 4 ounces of yellowish, frothy mucus. The profuse sweating continued, 

 and few hours later both pulse and respiration began to fail rapidly. It be- 

 came very evident that a return to medicinal treatment was necessary, and 

 1 mg. (1-50 gr.) of digitalin and .4 mg. (1-150 gr.) of atropin were given hypo- 

 dermically with much benefit. 



The periods of delirium were now of frequent occurrence and of long dura- 

 tion. When rational the patient declared that the choking sensation had en- 

 tirely gone from his throat, and that he was now sm.othering from oppression 

 over the epigastrium, and during a spasmodic attack would put both hands to 

 this region instead of to the larynx as formerly. It was, therefore, decided 

 to endeavor once again to administer a liquid by way of the mouth. Two ounces 

 of milk containing a fluidram of whisky was brought to the patient, and with 

 a little assistance and encouragement the entire contents of the glass were 

 swallowed without any great effort. On finding himself able to swallow 

 liquids again the patient asked for a cup of coffee, of which he drank a few 

 drams. About 30 minutes later both coffee and milk were vomited and all 

 efforts to repeat the same were forcibly resisted. 



In spite of stimulants the pulse and respiration failed steadily and the 

 patient became permanently unconscious, at which time 20 m. of ether was 

 given hypodermically and resulted in a sudden general clonic muscular spasm. 



External heat had been constantly applied to the trunk and extremities, and 

 digitalin and atropin given, either together or separately as occasion demanded, 

 until the patient's death of respiratory failure at 7 A. M., October 7, 3 days 

 (71 hours) after the onset of active symptoms, and nearly 6 days after the 

 onset of prodromal syrnptoms. 



The hyperesthesia was a prominent symptom throughout the 

 course of the disease, and became gradually more pronounced until 

 finally both before and after unconsciousness warm applications 

 could only be placed to the extremities very gradually and retained 

 in position with difficulty. Hyperesthesia, as a rule, was most 

 marked on the left side. Very slight stimulations, such as the 

 sudden entrance of light to the room, the running of water and the 

 ringing of the doorbell, were many times provocative of a spasm. 

 The reflexes were increased and the plantar reaction always down- 

 ward. The pupils became dilated and nonreactive about 8 hours 

 before death. 



Delirium began to manifest itself about 86 hours after the onset 

 of active symptoms, became more prominent during the administra- 

 tions of hyoscin, but was still present during the period of 9 hours 

 when the patient was receiving no medicinal treatment, and con- 

 tinued to the period of unconsciousness. 



During the entire course of his illness there was never made in 

 the presence of the patient any mention of or reference to dogs or 

 hydrophobia, and he was made to believe, so far as possible, that 



