inferiorly and posteriorly were the only signs appreciable. He still, however, experienced a sensation of oppression and constriction in the chest upon making any continued exertion, and a slight tickling cough during the night.

From this date, as he was able to leave the house and did not choose to confine himself, I lost sight of him until May 16th, when I was summoned again to him. I learned upon enquiry that he had continued to all appearance in much the same condition in which he left off the treatment (with the exception of a perceptible increase in his stoop latterly), until the night of the 14th, when fever and dyspnoea suddenly supervened.

Found him lying on his back with his head and shoulders considerably elevated. An attempt to assume the horizontal position or to turn on the left side was attended with a most distressing sense of suffocation.

Respiration short and hurried; cough almost incessant, and at times accompanied by a tenaceous muco-purulent expectoration. The right side of the thorax was notably distended, and the intercostal depressions obliterated; he also experienced in this situation a diffused soreness and a sense of oppressive weight. The sound yielded on percussion was morbidly clear at the summit, but became extremely dull on approaching the posteroinferior portion; respiratory murmur and resonance feeble and masked; metallic tinkling. Succussion revealed a distinct sound of fluctuation. Over the left lung the respiration was puerile.

The patient laboured under hectic pyrexia, and had a return of œdema; pulse small, rapid, and somewhat irregular; bowels regular; urine sparse, coloured, and sedimentitious.

Treatment.-Laxatives, opiates, and mucilaginous drinks.

The adema subsided, but the expectoration became freer, dusky and offensive.

May 20th. Pulse extremely feeble; profuse sweats; orthopnea; cough urgent, followed at intervals and suddenly by a copious, fœtid expectoration, amounting to a quart or more daily. The chest yielded much the same signs, with the exception of an amphoric blowing sound, heard during inspiration, and most distinctly when the stethoscope was placed between the angle of the right scapula and the spine. Tonics, opiates, generous diet.

May 22d. Pulse stronger and more developed; appetite good; sputa greenish, still copious, though less offensive. Orthopnoa relieved, so much so that he was able to lie in the horizontal position. The right side at its postero-inferior portion sounded clearer than it had done for some days previously; the distension of the parietes was sensibly lessened; and the respiratory murmur became partially audible in the infra-mammary region. The voice determined an imperfect pectoriloquy. When the patient coughed the sound traversed the tube to the ear in quick vibrations, and when the convulsive action ceased, a prolonged hissing and metallic sound was heard, which conveyed the feeling, as if the air in the cylinder had been forcibly sucked in. Med. ut supra.

May 26th. Cough less urgent; expectoration had gradually diminished in quantity since the last report; sputa of a thicker consistence and greenish hue; the amphoric blowing and metallic tinkling sounds had lost their intensity, and the respiratory murmur could be heard over a more extended surface. The hectic symptoms had somewhat abated.

May 31st. The right side of the thorax had again become greatly distended; its lower half sounded extremely dull, the superior portion gave a tympanitic clearness; gurgling; metallic tinkling; at times the blowing sound was very distinct; immobility of the side. The patient now lay easiest in a horizontal position. Whenever he attempted to rise he was seized with a violent fit of coughing threatening suffocation, which did not cease until a large muco-purulent expectoration (sometimes amounting to 4 or 5 oz.) had taken place. Fluctuation in the chest was heard whenever he coughed or moved. Respiration in left lung accelerated and puerile; hectic.

From this time to the 10th of June he continued in nearly the above state, using such means as tended to support his strength and alleviate irritation. His appetite, strange to say, never flagged a moment, and he appeared to digest what he ate. He ever cherished a lively hope and bore his sufferings with the most exemplary fortitude. June 10th. Countenance ghastly; great prostration of strength; colliquative sweats; pulse rapid, and the right side of the thorax still further distended, especially towards its inferior portion; the abdominal muscles of the same side retracted and tense; right thoracic parietes smooth; dyspnœa; cough exhausting; sputa muco-purulent and offensive; thrown up with some serum. Used anodynes and diffusible stimuli freely. In a couple of days he appeared to rally in strength; cough abated in violence, and the sputa became thin and reddish. In a few days more his strength was more decidedly improved.

June 20th. An erythematic blush, sore to the touch, appeared between the seventh and eighth ribs, beneath which signs of fluctuation could be readily detected; sputa of a thicker consistence, and dusky red colour, still copious. He was able to sit up without urgent dyspnea; pulse quick and small. I resolved upon resorting to paracentesis the next day.

June 21st. On removing the instrument the fluid gushed out to the distance of two feet or more. About two quarts of a dark red muco-purulent matter, apparently intermixed with serum, were drawn when the patient felt sick and faint. I immediately closed the orifice by inserting a small tent of soft sponge, supporting the same with a compress of lint and a broad roller. The matter last evacuated was grayish red, owing to the quantity of minute flocculi diffused through it. Odour very offensive. Opiates and stimulants. June 22d. He had obtained great relief and rested some during the night; cough much less troublesome; pulse quick, somewhat irregular; skin moist; discharge thinner; the distension of the right side had greatly subsided; the intercostal spaces were depressed, and the respiratory movements began to be developed (though obscurely) in the inferior portions. The right abdominal muscles instead of being retracted as before, now participated in the movement of respiration. Air was expelled with the fluid through the puncture, on coughing and expiration, and produced a loud gurgling, but on inspiration it was sucked in with a deep hissing sound. Sounds of the chest extremely clear anteriorly and superiorly, and dull posteriorly and inferiorly. On removing the dressings very little matter was expelled, but I conjectured from the appearance of the sheets under him, and the report of his attendant, that he must have discharged nearly as much as was drawn off at the operation. June 24th. Sputa now thick, whitish, and small: suction of air through the orifice in the side, much less forcible. A thin serous fluid of a dirty reddish hue, and containing a few shreds still continued to flow, but was now expelled in small quantities even when the cough was violent. The ribs projected outwardly, and his great emaciation was very evident. Pulse fuller; skin pleasant; appetite good.

June 26th. Discharge thin and slightly tinged, exuding occasionally through the puncture, which manifested a tendency to cicatrize; cough milder; expectoration still diminished in quantity. Percussion gave a less tympanitic sound over the right lung; dulness greater about the middle of the seventh rib and posteriorly. Metallic tinkling very distinct. A well marked murmur frictionis predominated towards the base of the right lung, over which region also the patient experienced a soreness; and when touched a sensation of tickling. Admeasurement of the right half of the thorax still gave an excess. His strength was so far improved that he could walk with little assistance across the room from one bed to another. June 30th. The discharge again assumed a semi-purulent character; cough frequent and hacking. July 2d. The puncture which had been gradually contracting now healed up. Dulness of sound more extensive over the affected side. July 8th. Matter having again accumulated in the chest, as evinced by distension, &c., I again resorted to paracentesis and discharged three pints of

semi-purulent matter of a dusky white appearance. July 9th. Discharge ceased after 10 o'clock A. M. July 10th. Felt much better; pulse improved in rhythm; cough occasional; sputa purulent; a thin ichorous fluid oozed through the orifice, staining the compresses. Gaining strength rapidly. July 12th. No hectic; cough only troublesome at night; sputa tinged a little red; both halves of his chest nearly equal; breathing easy; the patient is able to walk about the room without assistance. July 15th. Sounds yielded by percussion nearly of the same intensity over both lungs, with the exception of some dulness inferiorly in the right. Respiratory movements becoming equable; slight murmur frictionis; imperfect pectoriloquy. The patient preferred lying on the left side. Puncture healing. No signs of matter in the chest could be detected. July 19th. Coughed very seldom; expectoration had almost ceased; pectoriloquy still heard; puncture healed. July 22d. Gaining flesh and strength; sounds of the chest and movement of respiration nearly normal; pectoriloquy still audible, with a metallic tone. July 31st. He was allowed to take some exercise in the open air. My regular attendance on him ceased about this time. He returned to his work in September following, and since then has enjoyed uninterrupted good health. I saw him last on the 4th March, when he appeared in considerable embonpoint. A. G. TEBAUTT.

London Bridge, Va. March 20, 1839.

ART. II.-CASE OF HYDROPHOBIA.

BY WASHINGTon l. atlee, m. d. of lanCASTER, PA.
(Concluded from page 9.)

On Tuesday, February 12th, at 1 o'clock A. M., I was called up by a messenger, telling me that Mrs. Keely was much worse and that I should hurry over. When I arrived there, Mr. Keely informed me that while he was lying dozing on a chair, she alarmed him very much by suddenly starting up and flying across the room with wildness and impatience towards the front door. He asked her what was the matter, and she replied she wished to lock the door, and then as suddenly rushed towards the back door. Mr. Keely said that for a considerable time before this came on her she had been engaged in prayer, and in hearing the bible read according to her request, and that she expressed herself sensible of her situation, and was anxious to prepare herself for the final result. Before my arrival, and immediately after that spell, she had several spasms more violent than at any time before. She had taken one of the powders with great difficulty, and in attempting to take another it brought on very severe paroxysms, accompanied with ejectio urinæ. When the spasms became so violent she requested her husband to tie her, no doubt fearing that in those moments of intense agony she might injure some one. When I arrived, her children were in the room with her. She said that before she got so bad, she had felt extremely happy, and had her children called up around her—that she “felt as if she could go," and spoke a long time to her children and husband as one taking an everlasting farewell. She told me she felt so much composed when her mind was engaged in such reflections, and desired that the bible might be read again. I asked her whether I should read it for her, and she assenting, I enquired what portion of the Scripture she preferred. She replied, "the 52d chapter of Isaiah." I read that chapter slowly and distinctly for her, and when done enquired if I should read on. She said "I am afraid of tiring you, but I would like to hear more." I then continued to read eight or nine succeeding chapters, asking her at the end of every chapter whether I should read on. I then observed that perhaps there were other portions of Scripture she would like to have read. She replied, "you are too kind, but if you are not tired, I should like you to read of the sufferings and death of our Saviour." I then turned over to Matthew and read for her. During all this time she

remained perfectly composed and tranquil, although her spasms had been so violent before. Shortly after this my brother arrived. Upon asking her to let us see her tongue she became greatly agitated, her countenance became wild and suspicious, and with the appearance of great dread, she said "she could not bear the candle." She, was sitting with her back turned towards the candle, but she observed my brother reaching for it, and although the candle was not touched instantly she was thrown into the most violent paroxysm I had yet seen-her head was thrown about from side to side in dreadful anguish, and fearing that she might injure those who were holding her, I placed my hand upon her head to secure her-but her agony was very much increased, and she earnestly called out, "Take off your hand, take off your hand." My brother remained until three o'clock, at which time we gave her pulv. ipecac. grs. xx., acetated morphia gr. 1.

She hesitated for a long time before she took it, saying "I can take no more," and while preparing to give it to her she appeared violently agitated, and was seized with incessant spasmodic throbbings. She at last consented to try it, but would not have it moistened-it was mixed up with dry sugar, and she took it, and succeeded in swallowing it with great difficulty, but without much spasm. I remained with her until 4 o'clock, and during this time she had several very severe paroxysms. They sometimes would come on spontaneously, others would be excited by walking through the room, and agitating the air. Her dread of fluids was so great that no drink was offered to her. During these paroxysms, which lasted from half to a whole minute, the inspirations and expirations were quick and spasmodic, producing a singular sound by the concussion of the sudden ingress and egress of air, which, to a warm and prepossessed imagination, might seem to be a kind of barking. This no doubt has given rise to the vulgar idea that a barking like that of a dog is one of the symptoms of hydrophobia. The spasm generally commenced with a sudden, forcible, and spasmodic spitting very quickly repeated, resembling very much the spitting of an irritated cat, and ended with a deep inspiration or sigh. She frequently had very sudden convulsive sobbing inspirations-sometimes only one, at others two or three in rapid succession, and both in these and in the spasms her countenance would get much more wild and anxious. Her skin was moist, pulse rather quicker, and she complained more of the heat of the room. Prescribed a powder like the last to be given every two hours.

Before I took my leave of her this morning she seemed desirous of knowing my opinion of the result of her case. I told her that her disease was one of a very fatal character, but that we were not entirely without hope; that in consequence of the manifest amendment that had occurred in her symptoms, we had good cause for encouragement, and that if her constitution was good and the treatment was persevered in, the disease might probably wear itself out, and the system afterwards be restored to health. She replied she hoped that it might be so, but she expected a different result. I informed her that it was impossible for us to tell, at the present stage of her case, how her disease would terminate, yet as there was great uncertainty, it would be better for her to prepare for the worst, and then, in any event, she would be safe. She assented to what I said, and observed that she was not fully prepared to leave this world, and felt desirous of conversing with some person concerning the salvation of her soul. She said that if her mind was fully prepared, she was sure that in her moments of ease, between the spasms, she would feel resigned, and consoled with the idea that when she left this world of pain she would be happy in the other. Upon asking her whether she would like to receive the visits of a clergyman, she replied, "Oh! yes, I would be much pleased, but I am a stranger and know no clergyman.' I assured her that would make no difference, that either of them would call to see her with pleasure, and as she said that she had belonged to the Presbyterian church in Philadelphia, I would request the Rev. Mr. Davie to see her.

During this conversation she was quite calm and collected, and free from spasms.

Before going home I left her two more powders like the last to be taken two hours apart.

At 8 o'clock A. M. Mr. Keely called and stated that the powder we had given her at 3 o'clock, sickened her very much and produced some drowsiness, but no sleep. The other powder she found it impossible to take.

At half past 9 o'clock A. M. visited her again with my brother and Messrs. Landis and Maxwell, medical students. She had taken one powder this morning in her husband's absence. She was pretty much in the same situation as when we last left her, though she said she was worse, and the spasms stronger. The spasms appeared as if they were becoming more general, and they were now always accompanied with that peculiar noise. There was yet no tonic or tetanic rigidity of the muscles. The action of the heart was rather strong, and stronger than was indicated by the pulse at the wrist. Prescribed a blister to the præcordia.

At 11 o'clock A. M. I called upon the Rev. Mr. Davie and requested him to accompany me to see Mrs. Keely. At the time we entered her room the spasms were very strong, and she was suffering much agony when I introduced Mr. Davie to her. Her paroxysms were now more violent and frequent than before, accompanied with intense anxiety and horror of countenance, spasmodic noise, and an urgent desire for air, calling on those in the room to open the doors. During the spasms she requested those who held her to press strongly on the pit of her stomach. She complained of thirst and desired to have something with which she could moisten her mouth. She asked for coffee, but as it approached her she was seized with strong spasms; by repeated efforts, however, she drew in a little through a quill, and succeeded in swallowing it. Her respiration was frequently interrupted with convulsive sobs, and she was often hawking up and spitting out, as if phlegm was always collecting in her throat. She found it very difficult to speak, not appearing to have full control over the organs of speech: it appeared as if the attempt at speaking produced a spasmodic restlessness of the articulating muscles, which rendered it painful for her to speak. Becoming a little more composed she apologized to Mr. Davie for not being able to converse with him, but said she was glad to see him. He was engaged with her in conversation and prayer about half an hour, which had a most tranquilising effect upon her. During the whole of this pericd she was remarkably calm and free from spasm, although her paroxysms before and immediately after were frequent and of the most violent character. It would appear from this circumstance as if the exercise of the mind in this disease had some mysterious connection with the production of spasm; for as the paroxysms were entirely suspended while the mind was engaged in this all-absorbing question, and as they recurred so soon as the mind was not thus exercised, it would indicate almost as close a relation as cause and effect. The members of the profession will at once observe the correspondence between this circumstance in this case and a distinguishing feature of chorea, viz. the act of volition being necessary to the convulsive movements.

In consequence of the frequent recurrence of the spasms the blister was not applied to the præcordia. She this morning again requested to be tied, but as we found that she could be managed with safety we considered it unnecessary and forbade it. Before leaving her I applied more morphia to the blistered surface.

At 2 o'clock P. M. called to see her again with my brother. Her paroxysms had been frequent and strong since our last visit. She enquired of us whether bleeding would not weaken her, as if she desired it to shorten her existence. She said her "feelings were awful, no one knew, and wished it was over." She lamented about her children and husband, "that was her only trouble," and desired us to "comfort Mr. Keely." We attempted to give her another powder composed of submur. hydr. grs. xx., pulv. ipecac.