During the year 1S97 three deaths were reported to the coroner's office of Philadelphia as having been due to rabies. A thorough study of the cases by the approved methods of the day was made, and the deaths were all found not to have been due to rabies. In order to allay, so far as possible, the deep-seated popular dread of the disease, though not denying its existence, Coroner Ashbridge called attention to the fact that during his seventeen years' service in the coro ner's office not one of the many cases of hydrophobia so reported in the papers and investigated by those connected with the office had proved to be such upon careful inquiry. H. W. Cattell (Phila. Med. Jour., Jan. 14, '99).
Outbreak of rabies among the dogs of the District of Columbia. Eighteen chil dren and six adults have been reported to the U. S. Bureau of Animal Industry as having been bitten. Thanks to the Pasteur treatment, which nearly or quite all of the bitten persons have taken, there have not yet been any deaths from hydrophobia among human beings. There has, however, been much suffering from deep and lacerated wounds, from cauterization, and from the preventive vaccinations. The writer diagnosed rabies when the first post-mortem exami nations were made, but preferred to with hold his decision until all possibility of error had been removed by laboratory tests. These tests have now been com pleted and the results are conclusive. D. E. Salmon (U. S. Department of Agri culture, Bureau of Animal Industry, 1900).
Diagnosis.—There should be no diffi culty in distinguishing between rabies and other affections of the nervous sys tem in which spasms and cramp occur. In tetanus there is the typical trismus and an absence of any dread of water. The character of the wound in tetanus is also different and the incubationary period much shorter.
The greatest difficulty lies in dis tinguishing a true rabies from the pseudorabies above described. IIere a careful consideration of all symptoms and a complete and searching test of the nerve-reactions may be needed to prevent error. The evident influence of suggestion, the discovery of hysterical tendencies and stigmata, the absence of any real prostration and of any progress in morbid process shall exclude the psendohydrophobic cases.
Among the measures recommended by State Veterinarian Pearson to prevent the spread and suppress an outbreak of rabies is the immediate destruction of any animal that has with certainty been bitten by a rabid dog; in case of doubt the bitten animal should be quarantined for ninety days. For purposes of diag
nosis a dog suspected to be suffering from rabies should, if possible, be secured and confined and kept under observa tion; in ease of death a post-mortem examination should be made by a skilled pathologist, and the brain especially should be studied. When during an out break of rabies it is not possible to lo cate and secure all infected animals, all of the dogs in the district should be muzzled or confined. Editorial (Phila. Med. Jour., Apr. 8, '99).
In the clinical symptoms of hydro phobia the more the intellectual centres arc disturbed, the greater the difficulty of diagnosis. In most eases in man, however, the intellect is untouched until the last moments. In timid persons there may be fear of death as they per ceive the gravity of their disease. The great symptom is not "hydrophobia," but a disarrangement of inhibitory con trol of automatic reflexes of the throat and chest and muscular system, hyper sesthesia of the senses and skin, and a tendency thereby to convulsions. Some times the intellect is badly affected. J. Hartley Anderson (Phila. Med. Jour., June 3, '99).
The diagnosis of rabies may be estab lished by noting the alterations found in the central nervous system. The peculiar changes described by Van Ge huchten and Nelis may be of value. A normal nervous system cannot be present in a hydrophobic animal. G. Daddi (Rivista Critica di Clinica Medica, Apr. 7, 1900).
Investigations to ascertain whether the lesions of the plexiform ganglia of the pneumogastric were always present in rabies, as stated by Van Gehuchten and Neils. In the first dog, rabies, after 17 days of inoculation, and killed 17 hours after the first appearance of the symp toms, the cells of the ganglia were abso lutely normal. The same results were reached in a second dog, killed in the first attack after 23 days of incubation. The third dog, seized with madness after 32 days of incubation, had marked le sions of the ganglia. Half the cells were destroyed, and the whole of each gan glion was infiltrated with leucocytes. A fourth dog had very slight lesions. On the whole, the author thinks that when the results are negative the dog cannot be considered to have been free from sus picion of rabies, and the persons bitten should be taken to a Pasteur Institute. 31. Nocard (N. Y. Med. Record, from Bull. de l'Aead. de Mid., Apr. 17, 1900).