Translations.

A CASE OF LYSSA HUMANA.

BY P. H. KRETZSCHMAR, M. D., BROOKLYN, N. Y.

[New Yorker Med. Zeitung.]

TRANSLATED FROM THE GERMAN BY A. G. SINCLAIR, M.D., Professor of Diseases of the Eye, Ear and Throat, Memphis Hospital Medical College. Formerly Resident-Surgeon of the New York Eye, Ear and Throat Infirmary.

J. H., æt. forty-seven, native of Switzerland, builder by occupation, father of four children, all living, has until now enjoyed good health; has been a moderate drinker, an industrious man of business, and lived comfortably; has no hereditary taint, but is excitable and passionate.

On March 6th he discovered a strange dog in his back yard. As the dog refused to be driven away, he seized him by the back of the neck for the purpose of removing him, and received a bite between the thumb and forefinger of the right hand. By jerking his hand away, the part was torn, and the wound thus made more extensive than would otherwise have been the case.

Dr. E. F. Hartung, to whom the patient went at once, promptly cauterized the wound with nitrate of silver, and closed it with three sutures. On March 10th the sutures were removed, and on the 13th-that is to say, one week from the time it was received-the wound was healed. At the desire of the patient, the dog, unfortunately, was promptly shot.

Although Mr. H. did not seem at any time to apprehend serious consequences from the bite, yet this probability was occasionally discussed.

During the early days of May he was subjected to much annoyance and anxiety on account of a threatened strike among his employes, which he feared would render him unable to fulfill his building contracts. During this time, while engaged in a friendly but exciting debate, a large dog belonging to the person whom he was addressing, suddenly sprang upon him, seizing him by the beard, but not biting him. The dog was at once driven off by his master. This fright appeared to have a depressing effect on the patient. On May 11th he first complained of feeling seriously ill, and slept badly on the fol

lowing night. On the morning of the 12th, as he was about starting to his place of business, his wife gave him an effervescing powder, which he drank, but experienced great difficulty in the act of swallowing. Soon after this the peculiar spasms attending deglutition and respiration, which constitute the chief symptom of this disease, began to occur. During the paroxysms he stood or sat with his head and neck bent far back, his arms convulsively thrown about, the breathing deep and difficult, at times loud, and at times groaning and gasping. Dr. Hartung, who was then called in, prescribed for the "asthmatic" attacks bromide of potassium (ɔ̃ss hourly); it was not yet suspected that the disease was lyssa.

At 10 A.M. I saw the patient in consultation. As I entered the room a paroxysm occurred; the patient at the time was lying dressed upon the bed. A minute later, as a light was brought to the bed, a paroxysm occurred, and another as Dr. W. H. Kretzschmar entered the room a minute afterward. Water he drank with difficulty, pressing the glass against his mouth with both hands, and removing the empty glass from his lips with a rapid movement. This was immediately followed by another paroxysm. Without solicitation he dipped his hands in water, and evidently without aversion, but this was at once followed by a paroxysm, after which the slightest irritation sufficed by reflex action to bring on the paroxysms. Physical examination gave no result. Pulse 84, respiration 28-30.

The cicatrix, which had previously been white and smooth, now had a bluish cast, was somewhat raised and circumscribed by a narrow reddish zone. We thereupon found our diagnosis lyssa humana. Treatment: R Morph. sulph., gr. ; tr. hyocyami, m xii. At first hour two such doses were given, and afterward one hourly. The patient, however, obtained no sleep.

On May 12, at 7 A.M., the patient, for the first time, expressed the fear that he had hydrophobia and must die. The paroxysms occurred with great frequency. The dose of morphine was trebled (gr. §).

At 11 A M., after three such doses, no change had occurred. A careful examination of the buccal cavity showed none of

the so-called lyssa vesicles (Morechetti). The tongue was red but dry; the skin felt at all times normal; pulse 84, short and hard; mind clear; heart-sounds normal; respiration 28-30. Patient drank some water, some brandy (3iii in 24 hours) and soup, but would take no solid food.

At 3 P.M. he seemed much better; continued the foregoing prescription, was more quiet, paroxysms every eight to ten minutes instead of every two to three minutes. The dose was then reduced to morph., gr. .

At 11 P.M. patient again worse, pulse 140, small and weak, expectorated a great deal of tenacious mucus slightly tinged with blood, which he was obliged to remove from his mouth with his fingers.

He asked if amputation of the hand, or the excision of the cicatrix, an old German remedy, would not help him, etc. He knew, however, that he must die, and therefore thought that the sooner he did so the better, and desired the doctor to give him something to set him free. Speech was at all times disconnected and interrupted; consciousness at no time clouded.

On the following night he had paroxysms almost without interruption, but a quarter of an hour before death a remission occurred, and in full consciousness he bade farewell to his family and friends, and died on the 14th of May at 7 A.M., forty-eight hours after the appearance of the first symptoms, and sixty-nine days after having received the wound.

Earrespondence.

EDITORS MONTHLY-I was summoned on April 5th to attend Ellen R, colored, age about thirty, in labor, multipara. On my arrival found she had been in labor for twenty-four hours, and had suffered a great deal of pain. I made digital examination, and found the os dilated to about the size of a twentyfive cent silver piece; with no hemorrhage, but said she had lost a great deal of blood during the day. The labor pains had almost ceased; the liquor amnii had flowed away several hours before my arrival. She stated that she had not urinated for the past twelve hours; had a desire to do so, but could not accomplish the act. Complained of pain in the bladder.

I introduced a silver catheter and drew off about an ounce of blood, without the least odor of urine about it. As I withdrew the catheter I noticed a wild, vacant stare in the eye, and shortness of breath. I felt the pulse, and found it very quick and weak. I gave her stimulants with aromatic spirits of ammonia, but she died in a few minutes without giving birth to the child. She only lived thirty or forty minutes. after my arrival.

Now, what was the cause of death? Was it from exhaustion, loss of blood, uræmia, or rupture of the uterus? I hardly think it could have been from uræmia, because she had no convulsions. It may have been from rupture of the uterus, or exhaustion. Will be glad to hear from some of the readers of the MONTHLY as to the cause of death.

The regular meeting of the Shelby County Medical Society was held May 18, at the usual hour, with the President and Secretary in their respective places.

The members present were, Drs. Overall, Sim, Willett, sr., Willett, jr., Ford, Crofford, Heber Jones, Minor, Nall, and Williford.

Two members of the Committee of Censors having been elected to other offices in the Society, the President appointed a new committee, consisting of Drs. Willett, sr., Erskine and Thornton.

The essayist, Dr. Erskine, being absent, the report of cases was in order, and Dr. Crofford reported a new method of circumcision, suggested to him by Dr. Gant of Mississippi. The principal feature of the operation is that, a considerable portion of the mucous membrane is left, which is turned and sutured to the skin far back of the corona. The advantages

claimed for the operation are, 1st, The soreness resulting is less, the nerve supply at this point not being so great as near the corona; 2d, The parts can be handled better and with more ease; 3d, No urine can come in contact with the wound.

Dr. Crofford has performed one operation by this method, and is much pleased with the results.

Dr. Sim thought it a good method, as the third advantage claimed removed much danger from inflammation, as well as the dread children are often found to have in urinating, which causes them to retain their urine too long. He thought that sutures placed two inches from meatus would be too far back, and thought that immediately behind the corona would be sufficient for all the advantages claimed.

Dr. Willett, sr., thought it to be practically the same method as that practiced by the Jews, which he described.

Dr. Heber Jones said that it is no longer the custom among the Jews for the operator to suck the wound to prevent hemorrhage, but that after spurting a little wine on the parts, a dressing of balsam fir, sprinkled with Monsell's salt, is applied, and the wound left to heal without further disturbance. He advised that care be taken not to remove too much of the prepuce, as thereby the patient might suffer great pain from erection, and reported a case with such result, of many years' standing.

Dr. Ford suggested that Ricord's advice be followed, to-wit: "Outline the corona with ink, and cut to the mark." This would leave ample tissue.

Dr. Armstrong said that the operation, when performed for the removal of venereal sores, required the removal of a considerable portion of the skin; that he preferred general anæsthesia-that the local action of cocaine had not been satisfactory to him. His method is to slip a rubber ring over penis, cleanse with solution bi-chloride mercury, pass a director under prepuce along the glans penis, and cut; the prepuce having been removed, vessels are twisted if necessary, the skin and membrane united by sutures, and a dressing of iodoform applied. Though his operations had been for venereal sores, he has never had ill results, such as phagedæna, etc.