A REPORT OF A CASE OF RABIES.*

BY A. C. BARNES, M. D., GROVEPORT, OHIO.

On Sunday, September 4, 1904, at about 6 o'clock p. m. I received a call by telephone to visit a boy at some distance in the country. Replies to my inquiries regarding the nature of the illness indicated that the patient was having "spells" in which he did not get his breath well. I lost no time in getting to the patient. Found a boy five years old, of bright and healthy appearance, the third one of five healthy children in the family. Had been sick four days, gradually growing worse. The first the parents had noticed of the illness was on the preceding Wednesday at the dinner table. The child had exclaimed, "O papa, there's pins sticking me in the legs." Similar complaints were made from time to time, and the father had taken down the clothing to discover the irritating substance, but found nothing. Pains in the feet were subject of complaint, these pains gradually growing worse. Patient scratched outer aspect of left lower leg. Itching and pains became severe. On Friday there was complaint of sore throat. It was noticed that swallowing was difficult. Friday night patient was nervous, could not draw a long breath, breathing was "ketchy" and patient did not sleep well. On Saturday morning the bath did not agree. In the language of the mother the child "couldn't stand it to have water put on him. He wasn't afraid of the water, but it seemed to induce the spasm." Constipation had been present for a day or so.

At the time of my visit the patient was restless, standing and walking about the room. The cheeks were flushed and prolatia pale, suggesting pains of belladonna poisoning, or scarlet fever. Pulse regular and about 100. Axillary temperature, 102.5. Taking temperature under tongue was not attempted because of convulsive action of chest, pharynx and mouth. This action became exaggerated on approaching thermometer to the mouth. My usual admonition to "close the

Extract from a paper read before Columbus Academy of Medicine and State Medical Association.

lips but not the teeth upon the thermometer" could not have been heeded by this spasmodic patient.

Pronounced paroxysms involving chest and throat were occurring at intervals of about seven minutes or oftener if attempts to swallow were made oftener. He was eagerly desirous to drink, but on presenting a glass of water the spasm was precipitated and it seemed impossible to swallow more than a small portion. He was not afraid of water, but deglutition was well nigh impossible because of throat spasm induced by the attempt. To mitigate this difficulty the baby brother's bottle with its rubber tube had already been called in requisition.

At no time was the patient quiet. He would sit upon his father's or the doctor's lap for a short time only; sought frequent changes in position; and upon attempts to examine him or give him food or drink and upon exposure to draught, spasms were induced. Hyperesthesia was marked. Fear was not present. History of nervousness was denied. The patient had not been frightened by stories about mad dogs. The presence of the doctor did not disturb. Hysteria was not a factor. One question remained, "Is this the boy who was bitten by a dog some weeks ago?" The affirmative answer completed the clinical diagnosis.

The wound scars were upon the left lower extremity. One extended across the anterior aspect of the lower leg about one inch above the malleolar region from the inner side and above downward and outward a distance of about one inch. The tooth of the dog had evidently torn across and through the skin and superficial structures, causing considerable laceration. A second scar was over the outer malleolus, indicating a punctured wound without much laceration. The third scar was about one and one-half inches above the second and indicated some laceration. Above this scar there were abrasions caused by scratching. These scars were slightly elevated above the surrounding surface, the skin tensely drawn as if by an exudation underneath, of a rich port wine color and glazed appear

ance.

The patient had been barefooted when bitten, fifty-six days before symptoms developed, i. e., symptoms observed by the family. The offending dog was a dark colored cur, weighing

about twenty pounds, bedraggled with mud and bearing wounds in many places as if in frequent fights. This dog was pursued by the patient's father, shot and killed and thrown into the river. After this good (?) deed the patient's wounds had been dressed with turpentine.

By way of parenthesis I may remark that about the time of these occurrences a relative of the family told me a portion of this story. I suggested that the case be seen by a physician and the patient taken to a Pasteur institute; that a way of defraying the expense had been provided by a bill, for the passage of which by the last session of the General Assembly of Ohio we are indebted to Hon. Lewis B. Houck of Mt. Vernon. This message was conveyed to the family, but honored in the breech like many another piece of free advice.

The patient had not slept well the preceding night, and now natural sleep was out of the question. One-sixteenth grain morphine with atropine was administered hypodermatically and the same dose prescribed in solution to be administered through a glass tube every hour if necessary. An unfavorable prognosis was given, but removal to the Pasteur Institute at Chicago was advised and arrangements made to go by the earliest train, leaving Columbus the next morning.

I had some doubt about the patient living till morning or until the journey could be completed, but acted upon the slight chance gleaned from a few authors hastily consulted. The trip was undertaken, but the patient suffered a succession of convulsions, all symptoms grew rapidly worse and the patient died before reaching the institute.

PHYSICIANS' VACATION AND WHY WE SHOULD

TAKE ONE.

BY W. N. UNKEFER, M. D., PIQUA, OHIQ.

Vacation means vacuor or vacuum, empty, or thrown out, rest, stop. In our case it means cessation from work. Some people turn their vacation into dissipation; others into recreation. If used properly it is re-creation. What if you are a new creature? The physiological effect of rest is wonderful. It drives clouds away, paints in bright, new colors the dull round of daily care and duty. It inspires new interest in our patients, lends zest and enthusiasm to investigation, equips us to battle nobly with the duties and difficulties of professional life. The effects of overwork are: It lessens our perceptive qualities; incapacitates us from making a clear diagnosis; our constitution is weakened; therefore our patients suffer with us, as they need a bright countenance and cheery demeanor as well as medicines to assist them in their affliction.

I am sorry to say that many physicians by being overworked, and in an exhausted condition, have made use of drugs and stimulants to excess to tide them over a tired and weary condition, and to their sorrow no doubt kept on and on until it grew as if a part of them, when it seemed impossible for them. to cease using them, and they went from worse to worse until they died wretched and a premature death. I have known many such cases. They are to be pitied rather than censured. A man's vacation should be carefully adapted and sought to suit his own needs, both mental and physical. Some need the stir of the city as the country physician, always being where it is more or less quiet, might enjoy visiting hospitals and observing the different sights that are to be seen in every large city. Some would enjoy the lively scenes of the seashore, life near large hotels, and the busy throngs; some the bracing air of mountain climbing, taking nature's study, like birds or zoology; some sailing, others the quiet solitude of the forest with hut and gun. Who would begrudge a physician a few short weeks

man.

of rest and recreation? It is his duty to leave cares and tribulations behind and go away and stay until he feels like a new Come back and fight the battles over again. It is just as necessary that we have different varieties of scenery and occupation for the brain as it is different varieties of food for the body, in order to have a healthy constitution.

It is a true saying that "All work and no play makes Jack a dull boy." We need the rest to do justice to ourselves as well as our patients. No profession endures more hardships than the physician. He goes whenever and wherever called without very much remuneration at times, and often without rest. But he is always ready to administer to the wants of his patients, and does it cheerfully. We are servants of the public and consecrate ourselves to them. When pestilence walked abroad in our land and its victims were falling on every side, struck down by the invisible arrows of death, then did people on every hand flee for their lives. But the physician staid behind. Had they any shield to interpose between their defenseless breasts and the darts of the unseen foe? No. They had no other shield save that which every brave man carries-an invincible determination-the inability to acknowledge fear, an overpowering sense of duty. And they interposed their own bodies between a stricken people and the midnight wrath and fell by the wayside together with those they strove to save. We have in our city at the present time a few cases of smallpox. But the physicians labored day and night, especially our health officer, and assisted to eradicate it and protect the citizens from further danger. They do it and know not what minute they may be stricken down with the dread disease. Many physicians of the county, also state, can testify to the same.

In order to solve the mystery of the yellow death, men of our profession sought out and courted danger that they might rob the grim scepter of his mastery and his quiver of its most poisoned arrow.

The members of the United States Army Yellow Fever Commission, who suffered themselves to be inoculated with the most dreaded scourges, were just as truly the leaders of a forlorn hope as the uniformed band that storms a dangerous breach. Dr. Lazear died that others might live. He is not alone in his martyrdom, but stands enshrined in our hearts,