scribed alove, until it hung over the left nates of the mother, as is seen in the accompanying sketch. With the shoulders another difficulty now presented itself; this I managed by pulling the arm in the direction of the spine of the mother, and guiding it through the aperture with my left hand; while, at the same time, with my right I supported the head, and carried it forwards and upwards during the continuance of a pain. The shoulders were soon expelled, and the child was safely delivered. The cord was tied, and in ten minutes the placenta came away. A bandage, with a pad attached to it, was applied round the abdomen. On the injured part being examined, the rent appeared to commence a little above the verge of the anus, and to extend upwards for about half an inch; but the muscular fibres of the rectum had contracted, and reduced it to a mere fissure. It was carefully cleaned, and a piece of lint introduced into the vagina, to absorb the discharge and prevent it from passing between the lips of the wound. At the end of an hour I left her, with strict injunctions to keep herself quiet, and not to move about in the bed. Next day I learned that she had passed a comfortable night, and was as well as could be expected. She went on gradually improving; the fæces were expelled via naturali, not in the least tinged with blood. In the course of three weeks she was able to be up a little. Since then I have seen her frequently, and she expresses herself as being quite well.

The circumstances most worthy of remark in this case are,-1st. The unfavourable position of the hand of the child. This, in a female who has had several children, would not have been attended with anything peculiarly dangerous; but with a woman who is in her first confinement, the case is otherwise. There is then a great retardation of labour, and the danger of rupture to the perineum. 2d. The unusual position of the posterior commissure of the os externum. This commissure was thrust forwards by the head of the child to the inferior extremity of the symphysis of the pubis, so that the vulva was thereby very much diminished. I have observed that, in many first cases, the external parts are carried forwards; but in no other case that has come under my notice have I observed so great an alteration from the natural position. The state of the anus is also deserving of notice. It was dilated to a size considerably above that of a crown piece,- the mucous surface of the rectum being exposed and carried downwards, so as to be in a line with the perineum.

Lastly, there is the protrusion of the hand through the walls of the vagina and rectum; the subsequent closing of the lips of the wound; and the healing process advancing without leaving any fistulous opening between the two canals. This last particular is rarely the result without the aid of a surgical operation.

The treatment adopted consisted in the application of a lotion of the sulphate of zinc, attention to the bowels, and strict rest in the horizontal position.

PERTH, 16th October 1850.

ARTICLE IV.-Case of Hydrophobia. By JAMES STRUTHERS, M.D., Leith.

(Read before the Medico-Chirurgical Society of Edinburgh, 20th Nov. 1850.)

JOHN WESTON, æt. 8, was bitten, on the 13th October 1850, in the right eyebrow by a middle-sized dog. The animal was supposed to be mad, and was immediately killed. I saw the boy within an hour and a-half after the accident. There were two wounds, one above the eyebrow, an inch in length, and lacerated; the other immediately below the eyebrow, half an inch in length, and with a clean margin. Hemorrhage had ceased for some time, and the parts had been carefully washed.

There being reason to believe that the dog was mad at the time of the accident, I resolved to destroy the bitten parts as speedily as possible. The patient being much frightened and very unruly, was put under the influence of chloroform, without which it would have been impossible to have cauterised the parts satisfactorily, and without risk of injuring the eye. The two wounds were laid into one, the lacerated parts excised, and the whole of the raw surface carefully cauterised, first with the nitrate of silver, and then with the pernitrate of mercury; while the latter was being applied, one of the branches of the supra-orbital artery bled freely, and required a ligature.

The wound went on satisfactorily, and presented, at the end of the third week, a healthy cicatrix, with scarcely any deformity.

Nothing unusual had been observed in the behaviour of the dog previous to the day of the accident. In the morning he was noticed to be dull and restless, but took some food, and was observed once or twice in the course of the day lapping water in the usual way. In the afternoon he was observed rolling on the grass as if in agony, uttering at the same time a kind of suppressed bark or howl. It was at this time that the boy approached to caress him, when he sprang up and bit him in the eyebrow. Shortly before this the owner of the animal had given him some water containing nitre, which seemed to choke him, and caused vomiting.

The dog having been killed immediately after the accident, I was prevented from making any observations on his condition. There was nothing unusual, however, in the appearance of the body. The mouth contained some blood, but was free from froth, or fluid of any kind. On the following day I made a post-mortem examination of the body of the dog. The mouth, tongue, and pharynx presented nothing abnormal. The trachea and larynx were nearly filled by a rather firm clot of dark blood, which, as it did not extend into the bronchi, was supposed to have been extravasated at the time the animal was killed. The mucous membrane of the trachea and bronchi NEW SERIES.-NO. XIII. JANUARY 1851,

B

was much redder than natural; and there was some frothy fluid in the bronchi. The lungs contained much dark blood, and presented several spots of ecchymosis on their surface. The heart was normal, and the large veins near it were distended with dark blood. The œsophagus was natural. The stomach was the size of an orange, contained some air, and about three ounces of a dirty greenish coloured fluid, in which were two blades of grass, and some dirty stringy mucus. The other abdominal viscera were normal; the bladder strongly contracted, and quite empty.

On the 15th November, thirty-two days after the accident, I was called at two in the morning to see the boy, who, I was informed, had been complaining for about two days. I found him sitting in bed in his father's arms. He was restless and fidgety, never keeping the same posture for a minute at a time. His look was quite peculiar, and expressive of profound dread. His eyes were full and clear, and much more intelligent looking than usual. On being asked what was the matter, he said he felt pain in the wound, in the eye, and all over the same side of the head. The cicatrix was pale and natural in appearance. He answered questions rationally, and without any appearance of fear; put out his tongue when desired to do so; and gave me his hand to feel the pulse, which was 112, rather weak, and remarkably irregular. While holding his hand I blew suddenly on his face, when he sprang, convulsed, to the other end of the bed; covered himself with the clothes; shook, and cried very much; and beseeched me not to breathe upon him any more. This established the diagnosis.

On

I then learned the following facts-namely, that he had continued quite well up to the 13th November, his friends taking care not to irritate him in any way, or to make any allusion to the dog. the evening of the 13th, exactly a month after he had been bitten, he and some companions were out amusing themselves, when they were frightened by some one playing the ghost, and ran home. He refused to go out again, saying he was frightened. Immediately after this, on the ghost being mentioned, he began screaming and crying, complained of pain in the wound, in the eye, head, back, legs, and arms. He maintained also that his little fingers were bent and stiff, although his parents could not observe anything unusual. When any one happened to breathe upon him, he told them he did not like it, and to keep away from him. The same evening he took his supper, consisting of porridge and milk, in his usual manner, and without making any complaint. He slept but little during the night, was restless, and tossed about a good deal. Next morning he had some coffee for breakfast, but took only one mouthful, saying it would not go down. He tried water and milk, but with the same result. In the afternoon he ate a little biscuit, and took some milk, which he swallowed without difficulty. In the evening he asked for a potato, snatched it from his sister, took a bite of it hurriedly, and then pushed it away. He was restless during this, the second, even

ing, and became more so towards morning, when I saw him for the first time since the seizure.

His state then was as formerly described. When asked if he would have some water or milk, he refused at first, but afterwards offered to take either. He put a cupful of milk to his mouth, but immediately pushed it away in an agitated manner, and buried himself in the bed-clothes. He was then offered some jelly, of which he readily took two or three spoonfuls, but in an agitated manner, and as if in a great hurry. He then had a bit of soft biscuit, which he ate calmly; when swallowing it he was ordered to hold up his head, when the act of deglutition was observed to be performed deliberately, and without any spasm or hurry. When asked if he had pain in the throat, he said "Yes,” and pointed to the larynx. The tongue was clean, steady, and moist; there was no unusual amount of fluid in the mouth, and nothing like slaver on the lips. The breathing was calm, regular, and without noise. He was desired to get out of bed and to walk to the fire, which he did barefoot, on the cold floor, and without any agitation, and commenced warming himself. He was then offered a cup of cold water, of which he readily took a mouthful, but instantly drove away the cup, and ran into a corner, seemingly suffering from pain and spasm in the throat. The water was then warmed to blood-heat, when, after some pressing, he took another mouthful, which affected him in a similar manner, but not so severely. The temperature of the surface was natural, and there was no sensible perspiration. He could bear the legs, arms, and trunk to be handled and breathed upon without showing any uneasiness, but not so the face. He could also bear the head and spine to be tapped strongly, complaining only of slight tenderness from the head down to the middle of the back. A bright light presented suddenly caused slight agitation, but was soon borne with ease. The pupils were moderately dilated, and acted readily and equally. On being asked if he was afraid of anything, he hesitated, and would not answer me, but whispered to his mother that he was afraid of the ghost; and on being again asked, he told his father that he was afraid of the dog. He was now ordered 3ii. tincture of cannabis, with 3iij. of laudanum, of which he was to have half a teaspoonful every half hour.

At 8 A.M. his condition was much the same; he ate some biscuit and drank some milk during visit.

At 3 P.M. he was much worse. He could not remain quiet for a single instant. There was great general agitation, with constant spasmodic movement and jerking of the limbs; and every two or three minutes there occurred a fit of general convulsions, commencing about the throat, during which the countenance was distorted, and had a wild and savage expression. These fits occurred sometimes without any apparent cause, but were most frequently induced by his attempting to take anything in his hands, or attempting to swallow, or when he was breathed upon. There was now a profuse flow

of frothy fluid from the mouth, accompanied by constant hawking, and spasmodic working of the pharynx, with occasional retching and frequent belching of wind. The fluid was partly spat out and partly ran over the lips, whence it was constantly wiped away by the patient. He frequently asked for water, milk, and meat, and did not seem to have any dread of fluids except when he was pressed to take them, or when he attempted to swallow them. When offered any fluid in a cup, he would not take it, but would ask for a spoon, dip it into the cup, hold it for some time in front of him, make repeated and convulsive efforts to bring it to the mouth; then, with a look of great resolution, dash the spoon into the mouth, and throw it away. This was invariably followed by frightful convulsions of the whole body, which generally terminated by the belching of large quantities of wind. Once or twice he had spasmodic rigidity of the arms and hands, more especially of the right, and complained much of pain in the little fingers, experiencing great relief when they were squeezed. He was perfectly sensible, knew and named those around him, and answered questions rationally, but generally in monosyllables, and spasmodically, owing to the severity of the convulsions. He never showed the least inclination to bite or to hurt those around him. There seemed to be constant change of purpose and of thought. The senses of hearing, sight, and smell were preternaturally acute, though he once or twice said he could not see. It was impossible to deceive him in any way.

He was

At half-past 6 P.M. Dr Christison saw him with me. then weaker, and presented the same symptoms as in the afternoon, but in a less marked degree. The pulse was scarcely perceptible. He ate a piece of biscuit and took a mouthful of tea, which was followed by severe convulsive efforts to swallow, and by convulsions of the whole body. He was ordered to have a suppository, containing half a grain of the muriate of morphia, to be followed in half an hour by another containing a whole grain.

At half-past 8 P.M. he was much weaker; had become a little quieter after the second suppository; and was said to have vomited some blood. He was seen at this time by Drs Coldstream, Keiller, W. T. Gairdner, and J. A. Sidey. The pulse was all but gone at the wrist; he had still fits of convulsions, but much less severe than during the day. He was evidently sinking fast. He continued much in the same state till half-past 9 P.M., when he expired calmly, having been nearly free from convulsions for the last quarter of an hour, and apparently quite sensible. Death took place thirty-three days after the accident, and fifty hours after the first symptoms had shown themselves.

Sectio-Cadaveris.

The body was examined 36 hours after death, by Dr W. T. Gairdner and Mr John Struthers, in presence of Dr Keiller and myself.

External Appearances.-There was slight lividity of the general surface; and the posterior part of the body presented the usual post