BY A. ROSS MATHESON, M.D.

Read before the Medical Society of the County of Kings, May 20, 1890.

Through the courtesy of Dr. J. J. Ashley, of this city, I am permitted to present the report of a case I saw in consultation with him on December 2, 1888.

Miss J. R., age seventeen years, born in the U. S., and residing in New Jersey.

She had first menstruated when fifteen years of age, and afterwards at irregular intervals of from three to five months, and although somewhat anæmic in appearance, had always enjoyed fairly good health. On the 19th of August, 1888, while driving a strange cat out of the yard, the animal sprang upon her and bit her arm. A physician was called, who applied some local treatment and expressed the opinion that the wound was only slight, and that no bad results would follow. The patient and the family accepted this explanation, and the incident was soon almost forgotten. In the early part of November she began to experience slight headaches, loss of appetite, malaise and prostration, which was attributed to the irregularity of her menses and also to malaria. This condition continuing, it was deemed advisable to send her to Brooklyn on a visit, where she arrived on the 24th of November. On the 25th she complained of restlessness, insomnia, and pain in the fingers and arm which had been bitten. On the 26th attended a party in the evening and danced, and while returning home got her feet wet; slept well that night. During the 27th, 28th and 29th felt better, but had shooting-pains in the arm, which she described as "feeling like electricity." On the 30th she said she had slept but little during the night, and was suffering from nausea, vomiting, and orthopnoea. The pain in the arm continued, and there were several congested lines extending from the wrist to the elbow. December 1st, was unable to eat any breakfast; complained of thirst, but refused drink for fear of vomiting. At noon she drank some tea and ate some toast, after whieh she started for home. When on the street she felt so badly that she went into a drug-store for something to relieve her. The druggist administered some stimulant, advised her to return to the house and to send for a physician. Dr. Ashley was called; he found her lying on the bed; she seemed hysterical and would start up with a cry; sighed frequently and heavily, respiration quick, short and labored, temperature 102°, pulse 100, unable to swallow without feeling, as she described it, "as if I should lose my breath and die."

Administered chlorodyne and morphia, which was swallowed with considerable difficulty. The doctor visited her again at midnight. She was restless, starting up from sleep in a frightened manner, and complaining of a "feeling of suffocation." There was considerable secretion of frothy mucus, which she removed from her mouth with a quick sweep of the hand, as she would not allow the use of a cloth. I saw her in consultation, about 8 o'clock A. M., on the 2d of December. Her countenance was anxious, face pale, and pupils widely dilated, and her general appearance was that of a person apprehensive of some great impending danger. She was restless and irritable, and complained of painful sensations in the head, neck, back, and of a feeling of constriction or oppression in the chest; her respiration was quick, shallow and irregular; pulse 130, feeble and intermittent. We did not take her temperature, as she objected to being disturbed. There were paroxysmal spasms of the throat, larynx and chest, occurring at intervals of about ten minutes apart, some of which lasted twenty seconds or more, and prevented respiration. She complained of thirst, but any attempt at drinking precipitated a convulsion more severe than its predecessor, and some of the fluid was ejected at these times, but notwithstanding this she succeeded in swallowing some drink and liquid nourishment.

The symptoms of reflex excitability were the most remarkable I have ever witnessed. For example, a person walking in the room or speaking with his face toward her would provoke a convulsion. occurred several times during the visits of Dr. Ashley.

This

In the afternoon Dr. Landon Carter Gray saw the patient, and while speaking to her, although his face was at least four feet away from her, she exclaimed, as soon as her spasms would permit: "Doctor, please turn your face the other way, your breath is cold and it is killing me." Dr. Gray waved his hand, not violently, and yet so slight a disturbance of the atmosphere caused a spasm.

Her mental faculties were normal; there were neither delirium nor hallucinations at any time during her illness. There were several short periods of sleep during the day, which were abruptly terminated by the spasms, which continued until she died, about 7 P. M.

The treatment consisted in the use of such remedies as are usually employed in controlling or mitigating such symptoms, viz., bromides, morphia, chloroform, chloral hydrate, sulfonal, etc., and also nourishment and stimulants. These were administered by the mouth, hypodermically, by the rectum, and by inhalation.

Dr. Ashley was in attendance during the greater part of the day, and attended personally to giving the medicine and food.

An autopsy could not be obtained.

My purpose in presenting the history of this, to me, very interesting case, is to elicit the views of others regarding its character and classification.

Was it hydrophobia? Was it tetanus? or what was it?

The patient was bitten by a cat, but unfortunately the cat escaped, and its history is unknown. Assuming that the cat had rabies, we have a period of incubation of 103 days, attended by a series of prodromal symptoms recognized in hydrophobia, and succeeded by the characteristic phenomena peculiar to that disease, spasms of the muscles of the throat, larynx and chest. The spasms were clonic, unlike those of tetanus, which are invariably tonic, and affect the muscles of the back and limbs; neither was there trismus, nor opisthotonos, symptoms common to tetanus.

On the other hand, there was no delirium, hallucination, nor fear of water, aside from the dread that the act of swallowing might excite spasms. I have had many opportunities of observing tetanus, both traumatic and idiopathic, and on comparing the clinical features of this case with such observations, I am convinced that it does not come under that classification, and while it lacks some common symptoms and characteristics of hydrophobia, as defined by well-known authors, yet the principal and essential symptoms, the clonic spasms of the muscles of deglutition and respiration convince me that this case may be properly classified as hydrophobia.

In conclusion, I will state that all circumstances or reference that could possibly suggest any connection between her illness and the bite of the cat, or of hydrophobia, were religiously avoided in her presence -a course which I will recommend to all persons who may be brought in contact with cases of suspected hydrophobia.

PHYSIOLOGY IN THE SCHOOLS.

The following question and answer record what actually happened in a "deestrict school" in this State within a few months, in a junior class in physiology.

Teacher.-What teeth come last?
Pupil.-False teeth.

Communications in reference to Advertisements or Subscriptions (Subscription Price $2.00 per annum) should be addressed, Business Manager, BROOKLYN MEDICAL JOURNAL, 333 Hancock Street, Brooklyn, N. Y.

Remittances should be made by money-order, draft, or registered letter, payable to BROOKLYN MEDICAL JOURNAL, and addressed to Business Manager.

Authors desiring Reprints of their papers should communicate with the Business Manager as soon as the papers have been read, stating the number of Reprints desired, and the number of JOURNAL pages their papers will occupy, allowing 470 words to a page. Each contributor of an Original Article will receive five copies of the JOURNAL containing his article, on application at the Rooms of the Society, 356 Bridge Street

Photo-engravings will be furnished authors free of charge, if proper drawings or negatives are provided. Electrotypes of engravings will be furnished authors at cost, when they wish to preserve them for future reproduction.

Alterations in the proof will be charged to authors at the rate of sixty cents an hour, this being the printer's charge to the Journal.

All other Communications, Articles for Publication, Books for Review, and Exchanges should be addressed BROOKLYN MEDICAL JOURNAL, 356 Bridge Street, Brooklyn, N. Y

EDITORIAL.

THE CONTAGIOUS DISEASE HOSPITAL.

It is sincerely to be hoped that ere the present winter is fairly upon us the new contagious disease hospital at Flatbush will be ready for occupancy. That Brooklyn has been so many years behind other cities in the provision which it has made for those afflicted with contagious disease is a disgrace, which will, we trust, soon be wiped out. The want of such an institution has long been felt by the profession, and that the laity are beginning to appreciate it is shown by the fact that at the recent Commencement Exercises of the Packer Institute, an essay by one of the graduating class on "A Hospital for Contagious Diseases," was listened to with intense interest and the sentiments of the essayist heartily applauded. In speaking of the new hospital, Miss Evans, the essayist, said:

"The city has purchased five acres of land at Flatbush, where it will open in the fall a hospital for contagious diseases. It will consist of one pavilion for small-pox, another for scarlet fever, and a third for diphtheria. Careful provision is made for disinfection, and the building, when completed, will be one of the best equipped in the country. Unfortunately, it will also be one of the smallest. It accommodates at most but ninety patients. The same short-sighted policy which allowed the evils at Flatbush to continue so long, cut down the original appropriation from $65,000 to $45,000, and made no provision for measles, typhus or erysipelas. Even if more pavilions were built, the great need for convalescing wards and private rooms for pay

patients would not be touched. Few things can be more revolting to a person of even moderate refinement than to share a sick-room with twenty others. And a municipality has no right to force a citizen to either clear his house of boarders or send a sick man to a Flatbush hospital. The pennywise spirit of these grants is shown in the inadequate appropriation for salaries. Although scientific nursing may make a drain on the city's purse, it would be true economy to take advantage of the training that makes a genius of the born nurse and a capable caretaker of the intelligent woman."

PRELIMINARY EXAMINATIONS.

So much interest attaches to the subject of the preliminary education of medical students that we have thought it would interest the profession to see a list of the questions prepared by the Board of Regents and propounded to the would-be student of medicine. We have, therefore, in the present number published the questions submitted at the spring examination held in New York. It will be seen that these questions are confined to the subjects specifically mentioned in the law of 1889. The law of 1890 permits an examination "in their substantial equivalents approved by the regents," and in the recent regulations published by that body, a large number of studies are mentioned from which a student may make his selection. If, for instance, he has been so long out of school as to have forgotten his geography, he may substitute for it mineralogy or zoology, or botany, and a similar choice may be made from a prescribed group to take the place of the other subjects mentioned in the act.

The Regents have shown admirable judgment in the rules which they have adopted for the enforcement of the law, and from a conversation which we have had with the Secretary of the Board, Melvil Dewey, Esq., we are satisfied that everything will be done by that board to make the law beneficent and not oppressive.

THE MATTISON METHOD.

Dr. J. B. Mattison, of this city, is certainly entitled to have his name associated with the method which he has devised and perfected for the treatment of the opium habit. This method is distinct from either that of Erlenmeyer or of Levinstein, and is as original as either. In an exhaustive paper on "The Treatment of the Morphine Disease,' contributed by the doctor to the September number of the Therapeutic Gazette, the details of his method are fully described. Those who are interested can obtain reprints on application to the author.