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value has since been more fully observed by the present distinguished surgeons of that and other institutions in this city. Its object is, as you know, to secure the bleeding vessels without killing a piece of flesh with the ligature, and leaving that as a dead part in the wound, to provoke suppuration and endanger pyæmia. The practice of acupression, I observed, was growing into favor in many parts of the Continent, and even Professor Syme, of Edinburgh, who has always opposed the method, pays a silent tribute to it, by substituting for the ligature, the old-fashioned method of twisting the arteries, even vessels of the size of the radial and ulnar after the manner of Amussat. Professors Pirrie and Keith, of Aberdeen, have done most in perfecting this process, and find a wire loop, with a quarter twist of the wire on the needle, sufficient even for the larger arteries. It is impossible to say as yet how far we can extend beneficially the use of the method of acupressure. It is now used in a very simple way, to make pressure on the trunk of a vessel, in order to arrest the bleeding from some of its distant branches. And I think it quite possible it may yet be found reliable in the treatment of some forms of aneurism. Surely we must all admit, that we owe a great debt to that distinguished obstetrician and good man, Prof. Simpson, for its introduction.

The antiseptic treatment, by the use in various ways of carbolic acid, is considered by the distinguished Prof. Syme as marking a new era in surgical treatment. But its value is by no manner of means generally established. Prof. Lister, the son-in-law of Mr. Syme, is its greatest advocate. The theoretic grounds upon which the doctrine is erected are these: That there are septic germs floating everywhere in the atmosphere, to be found even in the dust that accumulates on the end of the finger, and which if they come in contact with the surface of a wound, are one of the chief causes that excite to suppuration. The carbolic acid kills these germs, so that if the surface of the wound is covered with this acid, diluted with water or oil, or mixed in a plaster, so as to completely exclude the air, there ought to be little or no suppuration. That there is great advantage to be obtained from the use of carbolic acid in this way, and in preventing suppuration after compound fractures, I have no manner of doubt, and Prof. Lister showed me many cases where, after serious operations, there had been no suppuration whatever, or but very little. Indeed, in a little work

by the late Prof. John K. Mitchell, of Jefferson Medical College, you will find a sort of outline of these same doctrines in his cryptogamous theory of the production of disease from atmospheric germs. The cool and fine climate of Scotland, and the airiness of their hospital wards in general, must have much to do in the healing of wounds without suppuration. It is no uncommon thing either in this city, as many of us can attest. In Aberdeen, Prof. Pirrie showed me cases where there had been similar good results without the use of carbolic acid, which he attributed to the use of acupression and their bracing climate. And among the cases he showed me were amputations of the breast, leg, and upper jaw.

NOTE. This admirable paper is an extract from a lecture delivered by Prof. Pancoast to his class.-E. S. G.

ART. II.-OBSERVATIONS UPON THE PATHOLOGY AND THERAPEUTICS OF RABIES IN THE HUMAN SUBJECT. Translated from the Jan. No., 1870, of Memorabilien, by Dr. T. C. HENRY. BY FREDERICK BETZ.

On the 3d of May, 1869, in the morning, at about 10 o'clock, a young man, seventeen years of age, F. B., was bitten by a dog, which latter, some days subsequently, was found to be rabid, and killed. About half-past 5, of the same day, I arrived at the residence of the patient, and found his injury as follows:

On the back of the right hand, and between the tips of the second and third metacarpal bones, was apparent a large brownish scar, somewhat circular in form. This was surrounded by a whitish circle, say three-fourths of an inch wide, with an elevated border, appearing, I should say, like the patches present in urticaria. Beyond this circle, the skin was normal in color and thickness. Moreover, there were no evidences evinced of pain or unnatural appearances. Although between the period of the reception of the bite and my arrival, some seven hours had passed, time enough, one would think, and more, for the absorption of the poison of the bite, no present apparent result was yet evident, until

I touched the wounded spot with my caustic carrier (or porte-caustique), when there was instantaneously manifested an extension and enlargement of the scar to the limit of the white edges; the bruised wound became larger as the scar showed, or was more clearly defined. I now incised the apparently healthful parts in the vicinity of the scar, and there was at once manifested an amount of suggillation, almost as extensive as if it were a new wound. This hurt would appear to be more serious in extent as one would infer. I applied caustic potash to the surface of the wound (all of a scruple was used), and over all applied a piece of hog's bladder, over that a cold compress, and prolonged this over the entire forearm. With a view of lessening the pain, I injected, hypodermically, about one-third of a grain of morphia. A copious spirt of blood followed the piercing of the skin, which was a sure indication of feeding of the veinsi. e., rapid absorption of the poison.

On the 4th of May, complains of no pain; repeat injection of morphia. Skin moist, diaphoresis.

May 5. Found elbow joint and axillary glands swollen. The caustic wound became almost the dimensions of a halfflorin. Injection of morphia.

May 6. Pain in the whole arm; as yet little suppuration noticeable. Injection of morphia.

May 7. Patient had yesterday some belly-ache and diarrhea; to-day, no pain, no thirst, sleep good, pulse 80-85 beats. The caustic crust began to loosen about the sides. Morphia injection.

May 8. The wound more highly inflamed; the loosening of the cauterized scar gave no more diffused appearance; head pained him all over; the tongue thin, having a shape like the commencement of typhoid fever, scooped, no thirst; pulse 60-70 beats, oppressed, retarded. Morphia injection. May 9. Yesterday vomiting, frequent hallucinations; thirst; swallowed without any trouble; no pain; pulse 60; felt himself better. Morphia injection.

May 11. No pain; general well-feeling condition; the scab more loosened. Injection of morphia, from the effects of which the patient daily experienced a profuse perspiration and a sound sleep.

May 13. The wound exhibited large granulating surfaces. The tendon of the extensor communis digitorum being exposed, the scab not yet altogether come off. No pain; also, besides, no exhibition of disease.

May 17. The wound is in a fair suppurating stage; the patient eats and drinks, as in good health, and goes out. The wound has been covered with granulation for as much as five days.

I saw the patient no more until the 14th of June. On that day the wound was not yet healed. It had remained about eight days nearly on an average the same; the suppuration had ceased, had become dry; the hand and arm were weakly and destitute of power-the whole arm, in fact, very painful; the feeling of the wound, painful; every jar of the body, by movements made, caused pain in the patient's arm; stinging in the ends of the fingers. All the fingers were sensitive; buruing in the soles of the feet, worse than after two days of exposure to frost; tongue red, with an alkaline reaction; pulse 90; patient giving off such a penetrating and disgusting perspiration that no one could endure being near him; headache. These symptoms made on me a very doubtful impression; then, there was no doubt that I had to deal with a harbinger of rabies. I concluded to attempt to calm locally, and to induce diaphoresis along with an effort to thin the blood by the aid of acidulated water. I prescribed one ounce of tr. opii with it, had a small saturated compress placed upon the wound, rubbing hourly the entire arm with the tincture of opium, and, at night, 15 drops of tinct. opii to be taken. Besides I ordered 2 drachms of acid. muriat. dil., every two hours 10 drops in one pint of water.

June 15. The patient had taken nearly 8 pints of water with 14 drachms acid; evidently perspired very much, and passed much urine, etc.; felt his arm easier, the head freer; the all-pervading exhaled odor had filled the whole room; I allowed him to continue treatment.

June 17. Patient tremulous; a swoon occurred, and vomiting, besides the tongue had yet the furred condition, but was somewhat red; the pain indurable. Continue therapy. June 18. Vomiting; tongue appeared depressed; bellyache at night, pain in joints, much lassitude. Now, I ordered peppermint-tea to be drank in great quantity, and, at night, 15 drops tinct. opii, to be taken regularly every four hours.

June 20. Since the 14th of June, odor continuing disgusting, the whole room filled with the steaming odor from the patient; one could observe about the same condition of system otherwise.

This lasted about eight days.

June 21. Lassitude, pain in the limbs; during nights specially in the joints; belly ache, thirst; pulse febrile 105, no headache; the tongue moist, not more trough-shaped, but even contracted. The neighborhood of the wound yet bluish red; the impression not very painful, besides the back of the middle-finger, somewhat. No more diarrhea. To provide against the still-continuing erythema, I ordered mercury subl., about grs. 2, and tinct. opii s. unguent pp. aa ung., to be rubbed every three hours into the hand and forearm; tinct. aconite uuc. 1, mercury subl. c. gr. 1, every three hours 10 drops. (Fuchs would have ordered sublimate hg. batts.)

On the 2d of July, the patient could be considered as convalescent, then he experienced neither uneasiness nor pain in his joints, nor were there other suspicious symptoms present. The wound gave out again healthful discharge of pus.

On the 5th of July, also, nine weeks from the period of the reception of the injury, he commenced again his occupation of a stone-hewer, and has remained since healthful (January 25, 1870). The injury left behind a very thick radiated appearance, but an apparently good scar.

This case afforded me a favorable occasion for many a reflection, besides occupying me in the five weeks, representing variations which had all the similarity presented that the onset of rabies often denotes. The wound tardy in healing the secretion of pus, alluded to its dryness. I saw a bluish a pect in it, the nerves connected with the wound round about were very sensitive, a typhoid condition associated with it. The interesting appearances were to me, most especially the all-pervading loathness, too appreciable by the olfactory senses, of the transpiration of the skin. As I observed myself surely a similar odor, it seems to that of a dog, which I saw myself as an accompaniment on several occasions. It is, therefore, my firm conviction that were the therapeutics so certainly depicted in this case, that the case must be determined to be an undoubted one of lyssa or rabies. I consider from that circumstance that the case was one in the disease known as lyssa, that the conditions were such that the irritation of the nerves being brought about, was, fortunately, successfully combated, and otherwise the pernicious matter brought out of the body through the skin, and poison modified by the caustic.

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