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. Penny backer, 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."

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

close her lips and refrain from sucking it out of the spoon. Having done this, and then emptying the spoon by inverting it, it was followed by a much lighter spasm than when drunk from a cup. In drinking with a quill, also, her spasms were weaker. It appeared as if the wetting of the lips and the effort of sucking in the fluid favoured the production of the spasm. Ordered the blisters to be dressed with Basilicon Ointment, and prescribed submur. hydrar. grs. x. pulv. ipecac. grs. ii.

On Monday, February 11th, 8 o'clock, A. M., I visited her alone. She informed me that she had altogether during the night about one hour's unsound sleep, and more in the early part of the evening than afterwards. She was not able to drink all night, she could not swallow, and thinks her spasms, on attempting to drink, were stronger and of longer continuance. She endeavoured to get down some drink by soaking it up with toast, but she could not. During the night, two spasms came on spontaneously while lying down. She said she was very bad early this morning-she experienced feelings of intense distress, and was thrown into spasms whenever the door was opened and admitted the cold air-felt her spirits give way—and her thirst was extreme. At this time she felt the spasms working in her every four or five minutes, although they did not break out, producing great agony. She continued in this way until she made several desperate efforts to drink some warm coffee, which she succeeded in forcing into her by means of a quill to the amount of nearly half a pint. This was the largest quantity of fluid she had taken since the spasms commenced, and it had quite a tranquilising effect upon her, causing the great anxiety and distress to diminish. After this she washed her face with a camphor rag, and while doing it she was affected with spasm. Although she expressed herself much better than she had been earlier in the morning, I noticed more anxiety and wildness in her countenance than the evening before. Her pulse was not quite so full, the skin rather below the natural temperature, the tongue more thickly coated with the same kind of fur, the breathing seemed rather more difficult, and was interrupted by peculiar sobs and deep sighs. While I was there she picked up a cold handkerchief to wipe her mouth, and it brought on spasm as soon as it touched her face. She had taken two powders after we had Jeft her last night, which produced vomiting of a yellowish, bitter and frothy fluid and some blood, but she postponed taking any more after 12 o'clock in the night in consequence of the great difficulty she experienced in swallowing them, and the sickness they produced-although she admitted that she was always relieved after vomiting. The blisters had drawn well-the cuticle being raised throughout their whole extent. I gave her another powder rubbed up in sugar, which, with the aid of coffee and the quill she succeeded in getting down, not, however, without considerable difficulty.

At 11 o'clock, A. M. visited her with my brother. Her skin was of the natural temperature and moisture, pulse fuller, tongue the same, and countenance less anxious. She had no spontaneous spasms since they still came on, however, on every attempt to drink. She complained that the heat of the stove sickened her, but she could not bear the doors open. On attempting to drink some coffee with a quill, she was thrown into a violent spasm, and succeeded in swallowing only a little. The powder which I had given her at my last visit caused her to throw off the same kind of fluid, and a living lumbricus. We examined the blister that had been dressed yesterday by the morphia, and the morphia appeared to be absorbed.-The fresh blistered surface on the neck was now dressed with acetate of morphia, and upon applying the cerate cold to the blister it produced a paroxysm. Her bowels not having been moved since Saturday, we prescribed in the form of pill, oleum tiglii 2 gtt. every hour until the desired effect would be produced.

At 3 o'clock, P. M. visited her in company with Dr. E. Parry. Her symptoms were about the same-pulse 88. She had taken only two doses of the oil, and without effect. Gave her another dose which she swallowed

with difficulty. Upon taking some tea after, she was thrown into severe spasms, and then said "she did not like to see drink come near her." Uniformly in taking drink she would hesitate, as before described, several times before she would place the cup to her lips, and as soon as she attempted to suck in the fluid the spasms would commence. She had got into a doze about an hour before, and was awakened by her son suddenly entering the room, which produced a violent paroxysm. Applied morphia again to a blistered surface.

At 6 o'clock, P. M. received word that she was no better, and that the medicine had not operated.

At o'clock, P. M. called again with my brother and Mr. Landis, a student. Her pulse was 90, skin and countenance the same. The lower gums and the sides of the tongue appeared excited, resembling the mercurial blush, but it was not attended with the coppery taste nor mercurial odour. She had had several very severe spasms from cool air coming over her face, and also from her attempts to drink. She got a most violent spasm when the family were at supper, caused by the noise of pouring out the tea. This spasm raised her off her seat, and was accompanied with a peculiar spasmodic noise, great horror of countenance, and throwing the hands about. We now spread 30 grs. of submur. hydrar. on a small piece of bread, part of which she ate without difficulty, complaining of it being very dry. We offered her drink, but she did not appear to want the cup; she took the quill out of the drink and hastily drew the wetted end through her mouth, thus catching a drop. This was followed by light spasm. We then advised her to dip the bread in tea, to moisten it, but she did not seem inclined to do it. Observing her dread of the fluid, I dipped it in for her, when she ate it. She said she had dozed a little, and she thought she could doze more through the night. She had taken since the last visit two doses more of the oleum tiglii, making in all 10 gtt. without any effect. Prescribed submur. hydrar. grs. xv. pulv. ipecac. grs. 3. to be taken every three hours during the night. (To be concluded in the next number.)

BIBLIOGRAPHICAL NOTICES.

Mütter on Club Foot.1

This is not the first work of this dexterous surgeon to which we have had to direct the attention of our readers in the course of our short editorial career. Dr. Mütter has readily embraced the new method for treating club foot,-(he is wrong in making Loxarthus and Club Foot synonymous,)—and in numerous cases, detailed in the volume before us, has been entirely successful. The book is illustrated by numerous wood-cuts, exhibiting the different deviations of the feet, and various instruments for rectifying the deformities.

The following are Dr. Mütter's remarks on the operation of tenotomy or of the division of the tendons, in cases where relief cannot be obtained by an appropriate mechanical apparatus.

"The operation which I prefer is precisely that of Mr. Whipple, with

A Lecture on Loxarthus or Club Foot. By Thomas D. Mütter, M. D., Lecturer on Surgery, Fellow of the College of Physicians, Member of the Academy of Natural Sciences of Philadelphia, Honorary Member of the Medical Society of Philadelphia, &c. &c. 8vo, pp. 104. Philadelphia, 1839.

2 See Med. Intelligencer, vol. i. p. 418.-Ed.