but the spasms were gradually, but perceptibly, increasing in frequency and force.

At five P. M., he was seen by Dr. Elliot, the attending physician. Twenty-four dry cups had just been applied to spine, laudanum 3ij, but with the addition (through a mistake of the nurse,) of gr. vj of the aqueous extract of opium, and powder of assafoetida 3 ss, was given per rectum; he drank some water and also some wine.

Seven P. M.,-Another enema of extract of opium and assafœtida, but with only 31 of laudanum, was again given; he now became drowsy, sleeping at intervals, but waking with a convulsion, and much frightened.

Eight P. M.-Becoming slightly delirious, wishing to rise and dress, as he thought it time to go to school; but upon all other subjects, as far as could be ascertained, he was perfectly rational; his mind was morbidly acute; when asked to do anything, he would immediately control his restlessness or jactitation, and instantly obey, appearing to be very anxious to comprehend and to do what was bidden, About this time he began to have slight spasmodic actions of diaphragm, accompanying or causing the rejection of whatever the stomach contained; the vomiting or rather difficult retching gradually grew worse, until at last, it became one of the most marked and distressing symptoms.

Nine P. M.-The patient was now seen by Drs. Metcalfe, Wood, Stephen-Smith, and other medical gentlemen. He became much excited by the presence of so many strangers. After becoming calm, Dr. Metcalfe asked him whether he suffered from pain any where; he answered that there was pain in his breast, placing his hand over the sternal region. Water was then poured into a bowl upon the floor, without his knowledge; but the sound caused a convulsion. A speck was then pretended to be seen upon his forehead which was gently blown upon, producing much excitement, and the continuing it brought on spasms; even the breath of the attendant would excite him. Warm milk-punch was then handed to him; as he would allow no one to hold the cup, he clutched it with both hands, and gradually, but spasmodically nearing his mouth, he gulped down the whole (about four ounces). Chloroform was then cautiously administered to him; even the vapor excited convulsions; it acted badly, causing lividity of the face, and close contraction of the pupils, which before were dilated; and nearly suspending respiration. He came out of the effects of the anaesthetic with a convulsion. When going under the effects of chloroform, he made some movements which seemed very much like attempts to bite. It was proposed by Dr. Wood to perform tracheotomy, and introduce a tube through which the patient might breathe, instead of through the irritated larynx; but one of the medical gentlemen rather opposed the operation, on the ground that patients with hydrophobia do not die with symptoms of asphyxia. During the evening he said, to use his own words, that "the doctors wished to

make him out mad; but he knew he was not, because he had killed the dog, and his father had paid the doctor fifty cents for burning out the bite. He had the "nerves." Another injection of laudanum was given, and also brandy by the mouth; he had already taken about eight ounces of wine, and three pints of milk.

Ten P. M.-Convulsions and vomiting increasing, and opisthotonos more marked. From the horizontal posture, he would suddenly spring upon his feet or knees, and stare wildly at some visionary object, and attempt to get out of its way; all the time spitting a tenacious, ropy mucus; head thrown back. About this time, he imagined that he had a pig in his mouth, which he at last, with difficulty, expectorated by the advice of the nurse; he also complained of a sensation of hairs in his mouth.

Eleven P. M.-He now became quite delirious, calling upon his parents and friends, and at times complained of headache; pulse too frequent to count, and very irregular. Injections continued.

Half-past twelve A. M.-He was now seen by Dr. Elliot. His tongue was cracked transversely, but not dry; the saliva, being very tenacious, and streaked with blood, was with great difficulty expectorated. The convulsions gradually increasing in frequency and force, were now very violent, requiring two attendants to hold him; for as soon as the paroxysms were over, he would immediately sink upon the bed exhausted. He died very suddenly at quarter-past one A. M., on Sunday December 14; living from thirty-three to thirty-six hours after the disease showed itself plainly, and ten hours after entering the hospital. His death was from exhaustion. The thoracic walls were immediately compressed: the air within being pressed out, and over the vocal cords, gave rise to a sound of very high pitch; so natural and shrill a shriek was it, as to startle all present, showing the vocal cords to be in a state of tension. Artificial respiration being continued, the same sounds resulted, but less markedly.

Post-mortem examination thirteen hours after death (dictated by Dr. Metcalfe.)-Rigor mortis well marked; body well developed; foam escaping from mouth; marks of the dog bite on the left hand at the root of thumb; tendency to ecchymosis on dependent parts; scalp congested; best marked on posterior part of left parietal bone. On making an incision along the back, about 3 iss of black fluid blood escaped; also blood between bones and membranes of cord; the spinal cord, on being removed, presented no morbid appearances; on opening the theca, there was considerable congestion of the vascular membrane, the blood being fluid. On removing the calvarium, the vessels of the dura mater were very much engorged; on removing this membrane, the pia-mater was found congested; puncta vasculosa abundant; contrast great between cortical and medullary substance; cortical darker than usual. The heart was contracted, showing what formerly would be called a marked case of concentric hypertrophy.

It is to be much regretted that a tube was not placed in his trachea as soon as he entered the hospital. Although patients, as a general rule, do not die by suffocation, yet it is conceded that the throat is the principal source of irritation, and from it arises many of the most aggravated symptoms; and the involvement of other parts of the system seems to be secondary, or at least to be aggravated by the spasms of the throat. Now, by the insertion of a tube in the trachea, one source of irritation, the continual passage of air over the irritated parts is removed, and they are allowed to rest; one of the most efficient of nature's means for the restoration of a part to its normal state.

If I was so unfortunate as to be attacked by this awful disease, I would insist upon the introduction of a tube into the trachea as soon as the disease was recognized, and that all remedies should be given per rectum.-[New York Jour. of Medicine.

Treatment of Obstinate Habitual Constipation.

Habitual constipation, although honored by a distinct name, is really (says Dr. P. Phabus of Giessen,) but a pathological symptom. Yet from its frequent occurrence and its manifold relationship in pathology, it has acquired for itself as much importance as if it were a distinct affection.

Its grave effects upon the whole organization, and also the popu. lar knowledge and recognition of the various remedies used for its amelioration, make it difficult for a rational physician to keep from administering purgatives proper.

Dr. Phœbus gives the following as the most frequent and potent causes. 1st, Too sparing use of ingesta that have a laxative effect. Here particularly should be mentioned water. A great many persons neglect to drink water to slack thirst unless when perfectly convenient, and after a while such prompting of nature is not reproduced to a proper degree. Also from custom many exclude fruit, milk, honey and oleaginous food from their dietary. Others from poverty are unable to procure the above named sorts of food. 2d, Too little exercise. 3d, Sluggishness of the large intestines. This latter is a fruitful cause. As the sphincters of the rectum are under the control of the will, so may the large intestines through the effect of the will in opening the sphincters and moving the abdominal muscles, be subjected to a certain extent to the same influence, as also by direct volition. We of course do not have anything like so direct a power over the large intestines, nor so ready as in the case of the sphincters, and hence the will must act longer before it produces its results. Once effected, however, it will be easier repeated. It will probably require efforts of the will to have a stool through these different means, viz: contraction of the abdominal muscles, and all rectal propulsion we may summon in moderation

for fifteen to twenty minutes. But every time the will is exercised in this way it acquires greater power. The movement of the colon is independent to some extent of the abdominal muscles, and is no doubt directly influenced by the will.

An especial sort of exercise should and may supercede all laxa. tives. It consists, 1st, In the repeated upward and downward movement of the rectum by the will; 2d, Rapidly repeated drawing in and out the abdominal walls. These should be practiced together, and must be commenced before the patient leaves his room with a determination to have a stool, and when once on the close stool, never to leave it until he has an evacuation. There are other kinds of movements that have a good effect, such as kneading the abdomen, rubbing it, moving the inferior extremities actively for some time; but the simplest and most effectual is the kind of exercise of the parts immediately concerned above directed. An adult ought to have one alvine evacuation every twenty-four hours, unless under special circumstances it is not desired. From costiveness many of the long list of digestive maladies and disordered nutrition occur, and much bodily and mental suffering. The sufferer should at a certain period in every twenty-four hours resort to the exercise recommended, and go to the privy. In a short time, after persevering in this sort of management, six or eight weeks for instance, a person may acquire so much control over the colon that he can expel its contests at will. This is so not only with the young, but also with persons in advanced age. With this the pa tient may be directed and watched over, as to his ingesta. The habit of drinking water enough may be established by using some of the waters containing carb. acid gas at first, and diluting until this is left entirely out.

A grown person ought in winter to drink in twenty-four hours at least from four to six pounds of water, and in summer nearly if not twice as much. The half should be taken before and the other half after dinner. These potations operate better on an empty stomach. To drink much during meal time generally disagrees with most patients, and drinking should be avoided for two or three hours before bed time, as a full bladder during sleep is often the cause of semenorrhoea. Riding and foot exercise does much good in getting rid of costiveness, but is not sufficient. Dr. Phoebus has had twenty-eight years experience in the above management of constipation, and thinks that it is more effectual than all other plans he has ever seen used. He has also seen all the diseases which so often depend upon, and accompany this condition, spontaneously disappear under these means pari passu with the costiveness. In cases where this procedure is not practicable, very old persons, those affected with prolapsus uteri, carcinoma recti, pregnancy, etc.,

This is contrary to my experience. I have known large potations of water on a full stomach to produce an immediate desire to stool In fact, this is a measure I frequently recommend.-TRANS.

he recommends injections of cold water. They should be preferred to laxatives internally, because they may be used for years without injury. And when necessary cathartics themselves should be administered per anum. He never recommends internal remedies of a medicinal character.-[Prager Vierteljahrexchrift. Nashville Jour. of Medicine and Surgery.

On "Phantom Tumours" of the Abdomen. By E. HEADLAM GREENHOW, M. D., Lecturer on the Public Health at St. Thomas's Hospital, Physician to the Western General Dispensary, etc.

I desire to bring under the notice of the Society a kind of abdominal tumour, often most embarrassing to the practitioner and very alarming to the patient, but of which I have been unable to find an account in any publication with which I am acquainted. We are indebted to Dr. Addison for the elucidation of the true nature of these tumours, and, in speaking of them, I shall adopt the name "phantom tumours," which he is accustomed to use in his clinical teaching at Guy's Hospital. During an experience of many years, I only remember to have met with seven or eight cases of the kind, in each of which I was expressly consulted for the tumour, and not for the derangement of health with which it is invariably associated. Probably, as the disordered health on which they depend is of very common occurrence, I should have met with these tumours more frequently had I sought for them. The five cases the main features of which I intend briefly to detail had all but one been seen by other practitioners before I was consulted. In the investigation of this excepted case, I had, as will subsequently appear, the benefit of being assisted by a leading metropolitan physician.

The first case of the series came under my notice so long ago as fifteen or sixteen years. The subject of it, a married lady aged twenty-six, had already borne several children, was in delicate health, and suffered especially from uterine derangement. She was anæmiated, unable to take active exercise, and complained much of anomalous pains, and of tenderness along the course of several large nerves. The greatest source of anxiety, however, was the presence of a tumour in the right lumbar region, appar ently about the size of a cricket-ball, but less regularly round. It appeared to be movable, and if attached posteriorly, to be so only by a narrow pedicle. The impression that it conveyed on a manual examination was that of a loose body floating upon or amongst the viscera. In character, the tumour was firm and unyielding, free from tenderness, and somewhat changeable in site; for although invariably to be found on examination, its precise relative position varied a little from day to day. I have neglected to note how long the tumour had existed, but several opinions had been