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after the first application of the ether, the reverse was the case. During the first week the left ear only was treated, and while the hearing of that side improved astonishingly, that of the other improved slightly and gradually, which, as I before remarked, was probably owing to an overflow of the acetous ether filling the œsophagus and passing through the eustachian tube into the cavity of the tympanum of the opposite side. On applying the ether to the right ear for the first time, the hearing distance was nearly trebled. During the treatment, the hearing distance, although diminished by a severe catarrh, was about forty times that when diminished by the same cause before the treatment was commenced. The hearing was always worse in damp weather, and as it was very rainy the last few days, this no doubt increased the effects of the catarrh.

Cataract in the Horse.

Some months since I performed the operation of couching on a filley of about five years old with entire success. The disease had affected both eyes, so as to render her entirely blind. The animal may now be seen in the vicinity of Fredericksburg, and is in the possession of a Mr. Perkins.

Very respectfully,

JAMES BOLTON, A. M., M. D.

ART. II.-ANOMALOUS DISTRIBUTION OF THE VERTEBRAL

ARTERIES.

BY RICHARD P. CATLEY, M. D., OF OHIO.

[Although the anomaly in the subjoined case may differ somewhat from those recorded, there are many examples of a similar irregularity of origin and distribution referred to by Meckel' and other anatomists.-Ed.]

Dr. Dunglison.

Philadelphia, March 15th, 1839.

Sir,-On the 8th of February last, whilst attempting the ligature of the innominata on the dead subject, at my residence in the state of Ohio, having exposed the vessel in the manner directed by Mr. Liston, of London, I tried to pass my finger from the division into the right subclavian and carotid along the innominata to the arch of the aorta; but, in so doing, I met with an anomalous arrangement, which, to the touch, seemed like a bifurcation of the arteria innominata. I immediately commenced a careful dissection of the parts, and found that both the common carotids, as well as the right subclavian, were given off by the innominata; and that, on the left side, there were two vertebral arteries, one arising from the arch of the aorta and entering the transverse process of the fourth cervical vertebra, the other arising from the subclavian and entering the transverse process of the sixth cervical vertebra as usual. I have preserved the parts in a preparation, which I have shown to Dr. Pattison, Professor of Anatomy in the Jefferson Medical College, to Dr. Horner, Professor of Anatomy in the University of Pennsylvania, and to Dr. Pancoast, Lecturer on Anatomy in this city-all of whom concur in stating that they have never seen or read of precisely such an anomaly.

Should you think this notice worthy a place in your journal you are at liberty to use it.

Believe me to be, sir, yours respectfully,
RICHARD P. CAtley, M. D.

I Handbuch der pathologischen Anatomie. B. ii. Abth. 1. s. 108.

ART. III.-CASE OF HYDROPHOBIA.

BY WASHINGTON L. Atlee, m. D. OF LANCASTER, PA.

[The following statement, contained in a letter to a non-professional friend, which has been sent to us-we presume, by the author-contains a full description of the sufferings of one labouring under this horrible disease.Ed.]

Lancaster, Feb. 20, 1839.

Dear Sir,-At your particular request I send you a detailed account of the symptoms and treatment of the case of hydrophobia which recently occurred in this city. In doing this I do not wish to be understood as approving of this method of publishing or recording cases of disease. Medical men have their medical journals, through which their communications can be offered to the members of the profession, to whom they properly belong. Nor would I have consented had I not known the exciting interest that is created in all classes of the community by the occurrence of this frightful disease, and, in consequence of this excitement, the tendency there is to magnify and falsify the circumstances attending the progress of the case. The strongest inducement, however, for consenting to adopt this method in making the case public, is to bring it more particularly before the medical practitioners of our own county, who, as the guardians of the health of our community, can have the benefit of the history of this case, should such a misfortune occur again in any part of our county. I shall avoid, as much as I can, with propriety, the use of those terms not capable of being understood by the common reader.

On Saturday, the 9th inst., I was called upon to visit Mrs. Elizabeth Keely. I found my patient to be an intelligent looking woman, of spare habits, of ordinary stature, and about 34 years old. She told me that she had an attack of rheumatism in her arm, and complained of pain the whole extent of the left arm, particularly in the shoulder. She informed me that she had felt unwell for three or four weeks before, and that on Wednesday previous she had perceived some soreness on the back of the hand, which continuing to increase, had traveled up to her elbow on Thursday, and becoming more and more severe, had on Friday reached the shoulder. During the progress of the pain, having received a phial of British oil from a neighbour, she rubbed it on her arm without receiving any relief. She then, of her own accord, applied a blister on the outside of her arm just below the shoulder with no better success. On Saturday, the pain becoming worse, and advancing into the left side of the neck, and through the arm-pit into the left breast, she thought it advisable to consult a physician, and I was sent for. I found the symptoms as above described, with the pain more acute in the joints than in any other part of the arm, taking on the character of the local symptoms of acute rheumatism. Her countenance was somewhat anxious, and her manner a little hurried. The tongue was lightly coated with a yellowish fur; the pulse, skin, and other perceptible functions being natural. I prescribed a blister to be placed over the spine, between the shoulders, and four cathartic pills composed of submur. hydrar., aloes socotor., convol. jalap., stalagm. cambog. and sapo castil., to be taken immediately. Upon taking leave of her, I directed her to send me word in the morning if she was not better, or sooner if she became worse.

On Sunday morning, the 10th inst., word came that she was no better. At half past 9 o'clock A. M. I visited her, and was informed by her husband that she had passed a bad night. Shortly after she had retired to bed, she was aroused by a sense of suffocation and tightness of the chest with pain in the præcordia or at the lower part of the breast bone. After this she could not sleep. Every few minutes throughout the night she would suddenly start up with a wild and anxious countenance, a sensation of smothering,

and with feelings of great distress. On attempting to drink, she discovered that she could not swallow, and that every attempt excited spasms in her throat, and aggravated these distressing symptoms. Her peculiar situation alarmed Mr. Keely very much, and he was on the point of starting for me several times in the night, but, through fear of causing too much trouble, he did not inform me until morning. At the time I was there she had become rather more calm and easy, though I observed occasionally a slight spasmodic action of her throat, and some hurry of speech. She picked up a bottle of spirits of camphor off the stove and smelled it, and immediately she was seized with slight spasms of the chest and neck. On repeating it the same results followed, when she gave the bottle to her little daughter, telling her to take it away. There was a wildness and an impatience depicted in her countenance during these spells totally different from any thing I had ever observed in other spasmodic affections. Even after these spasms were off she had an expression of anxiety, and complained of great pain and soreness of the præcordia and weight on her breast, with an inability to swallow any thing. The most distressing symptom was the pain in the præcordia. The blister had drawn well, but instead of being placed over the spine, it had been applied midway between the shoulder and spine; and the pills had operated freely. Her tongue was still coated with a yellowish fur, and her pulse free from excitement. The pain in the arm was entirely gone, excepting a little uneasiness she experienced in the shoulder.

It was during this visit that I was first informed that she had been bitten by a mad dog. She resided then in Philadelphia, and while walking along the street, a dog rushed out and bit her in the back of the left hand, causing an extensive lacerated wound extending down to the sinews. After going home she returned to the place where she received the injury to ascertain the condition of the dog, and discovered that he had been chained up for mad, and had just broken loose as she was passing by, and bit her and several others, and that he had afterwards been killed. She immediately consulted Dr. Pennybacker, of Philadelphia, who ordered her to soak the wound in salt water, and afterwards to apply to it a salt poultice. This was on Saturday, the 3d of November last. On Monday following she called on Dr. George McClellan, who was not at home. On her way home she called at the house of a friend who advised her to employ Stoy's cure. They informed her that about eighteen years before, two of their children had been bitten by a mad dog, and the attack of hydrophobia was prevented by taking Stoy's medicine. They procured the medicine for her, and she went through a full and regular course of it, commencing on that day. The medicine had the effect of producing copious vomiting on the two first days that she took it, but not afterwards. Shortly after adopting these precautionary measures, the family removed to Lancaster. Since their removal to this place she enjoyed good health until about three or four weeks ago, from which time until the period of her attack, she said she was not very well." The wound had healed up well, but the scar always remained tender and livid, and she frequently felt a numbness in her arm, accompanied by a sensation best understood by the term "asleep."

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After giving me this history of herself, she said she did not believe her present sickness proceeded from the bite of the dog. Knowing the powerful influence that the mind exerts upon diseases of this character, I encouraged her in this idea, and was careful in directing my enquiries to her to avoid exciting in her any suspicion that I believed it. Although apprehensive of the nature of her disease, and strongly desirous of employing certain means of confirming my opinion, I cautiously avoided every thing that would lead her mind to a different result. I think, however, that although she openly discarded the idea that her illness proceeded from the bite of the dog, her manner disclosed that she secretly believed that to be the cause.

I prescribed a combination of submur. hydrar. pulver. ipecac. aa 5 grs. to be taken every two hours.

Upon my way home I met my brother, Dr. John L. Atlee, and told him my fears respecting my patient, requesting him to hold himself in readiness to visit her in company with me, in case I was more fully convinced of the character of the disease upon my next visit.

At one o'clock, P. M. of the same day, I visited her again. She received me tranquilly, and expressed herself glad to see me. Her symptoms were now more distressing than they were before. She had a more wild and anxious look; her breathing was accompanied with a short convulsive sobbing inspiration; and the spasms of the chest and throat were more violent, and came on spontaneously every few minutes. There was no febrile excitement. Her tongue, pulse and skin continued the same. I examined the wound particularly. It still retained its livid appearance, but it was entirely free from tenderness. She had taken one dose only of the medicine, and that with the greatest pain and difficulty, and accompanied with violent spasms. She said it almost choked her when she attempted to swallow it. A short time after she had taken this powder, sickness of the stomach came on, and she vomited three or four successive times, ejecting a quantity of slime. During the last act of vomiting from this powder, she threw off a considerable portion of blood. In consequence of the distress and difficulty produced by taking the first powder, she had desisted from the attempt of taking any more, although she said she felt relieved after she had vomited. Her attention was now directed to her power of swallowing. She said she could not swallow. In reply to my several queries, she observed that she could not explain the reason of her difficulty to swallow: her throat was not sore; she could not say that she had any dread of fluids; she was willing and desirous of taking them; yet whenever she attempted it, she was seized with an intense sense of smothering, and spasm of the throat, which she could not control. Upon expressing my desire that she should overcome this spasmodic action of the throat by a strong effort of her mind, she replied, "Well, doctor, I will try." She then took a cup containing a little toast water off the stove, and clearing out her throat, she prepared herself for drinking. I now watched her with the most intense anxiety. She carried the cup half way up to her mouth, then stopped. Her countenance at this time was most peculiar and indescribable. Her features were set, fixed. It appeared as if the energies of her mind were concentrating themselves for some dreadful effort. She carried the cup near to her mouth, then stopped again. I could observe in her fixed and determined countenance a commingling of much excitement and alarm. I could there read the unconquerable dread of a fluid. She put the cup to her lips-and at once the horrors of hydrophobia burst upon me. I shudder even now at the recital-but it cannot be described-it must be seen. The cup had no sooner touched her lips than she was thrown into violent spasms. First, a sudden, quick convulsive inspiration, accompanied by a noise as if the air was drawn forcibly through a very narrow chink-violent contraction of the muscles of the neck and face, and drawing up of the shoulders and breast, and great retraction of the pit of the stomach and abdomen. The skin of the throat in front of the larynx was corrugated by spasm. Her countenance expressed the greatest anxiety and distress, and her body was thrown forward by the spasmodic action. This dreadful agony lasted about half a minute. As soon as it was over she said, "Doctor, I will try it again." Precisely the same scene followed. Again she tried it, and succeeded in getting about a teaspoonful into her mouth. Now making two or three painful efforts at deglutition without avail, with one desperate effort she swallowed it.

It must be at once perceived that my patient was a woman of extraordinary resolution and firmness, and knowing this, I urged her to take her powders regularly in spite of the difficulty. She said, “Doctor, I suffer very much from the attempt, but I will take them." Her husband remarked to

me that he believed her illness proceeded from the bite of the dog. She replied "No-it's rheumatism, I'll soon be better of the spasms." Although she seemed unwilling to permit her mind to believe it, yet I think she was perfectly conscious of the truth of her husband's opinion.

After ordering a continuance of the medicine already prescribed, and the application of a large blister along the course of the spine, commencing at the nape of the neck, I left her.

At half past 3 o'clock, P. M. I visited her in consultation with my brother, Dr. John L. Atlee. The introduction of my brother produced no unusual agitation. She appeared glad to see us, and was quite observant of the common courtesies of life, getting up and offering us chairs, and requesting us to be seated. She had taken another powder, but with great difficulty. This was succeeded by vomiting a large quantity of yellowish green slime, and some blood, which entirely relieved her of the pain in the præcordia. Since the vomiting had ceased, there had been no recurrence of the spasms, unless she attempted to drink, and then they were less violent. She expressed herself much better, and perfectly free from pain. The stricture and weight on her chest diminished, and there was less anxiety of the countenance. No febrile excitement-pulse, in an upright position, was 84; in a recumbent posture, 72 in the minute. The fauces, or throat, was free from irritation, except a narrow stripe of red on the edge of the right palatine arch, which appeared more like mere engorgement of the capillary vessels than inflammation. She had no soreness or pain in the throat. There was some tenderness, particularly during spasm, on both sides of the neck immediately below the mastoid process. There was no tonic rigidity of the muscles of the neck, as occurs in tetanus or lockjaw, and even during the paroxysms of spasm, the tension was confined to the respiratory muscles. We offered her different kinds of drink, all of which were followed by spasm, less violent, however, than before. Cold drink caused stronger spasms than warm did. In consequence of the blister having been applied much lower down than had been ordered, and with a view, also, of extending the decorticated surfaces for the purpose of introducing medicines into the system by means of the endermic practice, we ordered another blister over the back of the neck. Applied I gr. of acetate of morphia sprinkled on simple cerate to the blister on the shoulder blade. After administering another powder, which she swallowed with less difficulty, we left her.

At 6 o'clock, P. M., information was received that she was no worse. At half past 8 o'clock, P. M. we saw her again.-The change for the better was quite evident on our first entering into the room. Both she and her husband expressed their gratification at her manifest improvement. She had had no spontaneous spasms since our last visit, excepting one, and that came on her while lying down. I would observe here, that there was always a much stronger tendency to spasm when in a recumbent posture. Her spirits were much improved, and her countenance less anxious. The spasms caused by drinking were much lighter. There was no pain in the præcordia, and the skin was soft and moist, and pulse 90. The powder we had administered at our last visit produced vomiting of the same kind of fluid without blood. She had taken another dose of it about an hour before, which had not been followed by vomiting. She said she felt drowsy and thought she could sleep. On handing her a piece of dry toast and requesting her to eat, she took a small bite, chewed it and swallowed it with tolerable ease, and repeated it two or three times. Observing that it was rather dry, we offered her a drink, but as soon as she placed it to her mouth the spasm supervened, though less violent than before. Toast soaked in water could also be eaten in small bits without spasm.-She tried to drink repeatedly, and succeeded in getting a little down, and it was always attended with spasm. Noticing that the spasm commenced just at the moment she attempted to draw in the drink into her mouth, we suggested to her another plan: to open her mouth wide, permit us to lay a teaspoon filled with water full in her mouth, then

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