RABIES 193 



" These lists are made out and put on the table the day before the 

 treatment, and are entered in the case book, which records the 

 circumstances of the patient's case, e. g., name, age, seat of bite, 

 number of bites, animal that inflicted bites, cauterized or not, what 

 has become of the animal, etc. 



" The temperature of the cord room and of the outside atmosphere, 

 and the results of the culture are recorded in a book on the table in 

 the main room. We now take the tray and go to the patient. 



Treatment of the Patient. "The patient is permitted to stand, 

 sit, or lie down, as he or she may desire. The Pravaz syringes and 

 needles, which have been filled with 3 per cent, carbolic acid solution, 

 are emptied and washed out with sterilized water. These syringes, 

 holding 3 c.c., are filled by thrusting a needle through the paper cap 

 of the wine-glass; then the abdominal region of the patient is bared 

 and the site of the injection (hypochondria, or anywhere on abdomen), 

 avoiding large veins, is wiped with filter paper wet with 3 per cent, 

 carbolic acid solution. Then the skin is raised in a fold between the 

 fingers and the needle is thrust well into the subcutaneous tissue. 

 It is important to avoid injecting the layers of the skin, which is 

 painful, and to avoid sites of previous injection. After the injection 

 a piece of filter paper wet with the carbolic acid solution is put on 

 the skin and allowed to remain for a few seconds. 



" We have not modified the dose relative to age. In our youngest 

 patient, a girl, aged two and a half years, and a woman, aged eighty- 

 four years, the same doses were given. At times there are redness 

 and induration in the connective tissue, but there has never been pus, 

 never cellulitis of the slightest gravity. Hot-water applications on 

 towels suffice to remove any trivial inconveniences. The treatment 

 occupies twenty-one days at least. 



"First day (thirteenth- and fourteenth-day cord) 3 c.c. each at 

 the same time, and so on until the sixth-day cord is reached on the 

 fifth day; two injections of the sixth-day cord emulsion are given 

 in doses of 2 c.c. each at the same time; subsequent injections are: 

 sixth day (fifth-day cord), 2 c.c.; seventh day (fourth-day cord), 

 2 c.c.; eighth day (third-day cord), 1 c.c. Injections are pot given 

 of cords earlier than the third day. Now begin again with fifth-day 

 cord and come down to third-day cord inclusive; these all now being 

 2 c.c. doses. 



" If it be thought desirable to approach at first the more virulent 

 13 



