660 THE BOOK of THE Doc. 



manage, by means of two curved incisions, to cut the piece out without actually touching the 

 skewer with the knife. This plan was first proposed, we believe, by Abernethy. 



The second part of our preventive treatment might aim at the prevention of absorption 

 by Lafosse's plan which is at least feasible of giving at intervals large quantities of water 

 to drink, mixed with some brandy and ammonia. This may be kept up for days. 



The third is the exhibition of blue-pill, or a mercurial in some form, to an extent which 

 shall cause salivation. Whether this does any real good is of course extremely doubtful, but if 

 the patient has been bitten by a really mad dog, no means that awakens even a glimmering 

 of hope of preventing hydrophobia is to be despised. 



Afterwards, the mind of the individual who has incurred the unfortunate accident must 

 be quieted and rendered cheerful by the best means in our power. Some course of tonic or 

 alterative medicine should be prescribed, with perhaps the frequent use of the Turkish or 

 vapour bath. If these, however, have a tendency to cause the thoughts to dwell upon the 

 recent injury, change of scene and residence, or travelling, must be ordered instead. 



We must not, of course, forget to dose the dog as well as the bitten person. He ought 

 to be put under veterinary supervision, and in no case destroyed. If he should really die 

 rabid, the fact had better be kept a secret from his victim ; but if he should live, and seem 

 in good health, what a relief to be able to tell the bitten individual and his friends, " Well, 

 such-and-such a dog isn't dead after all ; so that is all right, and it is a pity we inflicted 

 the pain of cauterising the bite." This, said in an off-hand sort of a way, would go far 

 to prevent " mental hydrophobia," and tone the patient's mind up to a healthy standard. 



The indications of treatment of a case of undoubted hydrophobia are two viz., to endea- 

 vour, as far as possible, to ease pain and tranquillise the mind. 



The most complete quietude, combined with absence of gloom, must be maintained in all 

 the patient's surroundings. The attendants ought to be attentive, cheerful, but not officious. 

 No muttering or whispering, either in the patient's room or in an adjoining room, must be per- 

 mitted, and the fewer visitors, and the more absence of all seeming concern, the better. He 

 ought, if possible, to be made believe he is suffering from quite a different disease. 



The room should be darkened, without excluding the air, and any mirror or other glittering 

 object had better be removed, or the poor patient so placed that he cannot perceive it. 



The whole house is to be kept as quiet as possible ; for we must not forget that 

 distant noises, as of articles falling, as well as sudden draughts of air and the sound of fluids, 

 induce the terrible paroxysms. If during the fits a tendency to bite is observable, the end 

 of a stick rolled round with a soft rag and dipped in water may be placed in one side of the 

 mouth. Who knows but this may give even great relief? for we do not look upon the 

 attempts to bite as characteristic of a wish to inflict injury, so much as a desire to relieve 

 an excessive and unbearable itching in the gums. 



The administration of the hydrate of chloral in repeated large doses, administered as an 

 enema, affords, we think, the best chance of producing sleep and easing pain. 



