To neutralise the toxins that have already reached the spinal cord, 5000 units should be injected intra-thecally daily for four or five days, the foot of the bed being raised to enable the serum to reach the upper parts of the cord.

The quantity of toxin circulating in the blood is so small as to be practically negligible, and the risk of anaphylactic shock attending intra-venous injection outweighs any benefit likely to follow this procedure.

Baccelli recommends the injection of 20 c.c. of a 1 in 100 solution of carbolic acid into the subcutaneous tissues every four hours during the period that the contractions persist.  Opinions vary as to the efficiency of this treatment.  The intra-thecal injection of 10 c.c. of a 15 per cent. solution of magnesium sulphate has proved beneficial in alleviating the severity of the spasms, but does not appear to have a curative effect.

To conserve the patient’s strength by preventing or diminishing the severity of the spasms, he should be placed in a quiet room, and every form of disturbance avoided.  Sedatives, such as bromides, paraldehyde, or opium, must be given in large doses.  Chloral is perhaps the best, and the patient should rarely have less than 150 grains in twenty-four hours.  When he is unable to swallow, it should be given by the rectum.  The administration of chloroform is of value in conserving the strength of the patient, by abolishing the spasms, and enabling the attendants to administer nourishment or drugs either through a stomach tube or by the rectum.  Extreme elevation of temperature is met by tepid sponging.  It is necessary to use the catheter if retention of urine occurs.

HYDROPHOBIA

Hydrophobia is an acute infective disease following on the bite of a rabid animal.  It most commonly follows the bite or lick of a rabid dog or cat.  The virus appears to be communicated through the saliva of the animal, and to show a marked affinity for nerve tissues; and the disease is most likely to develop when the patient is infected on the face or other uncovered part, or in a part richly endowed with nerves.

A dog which has bitten a person should on no account be killed until its condition has been proved one way or the other.  Should rabies develop and its destruction become necessary, the head and spinal cord should be retained and forwarded, packed in ice, to a competent observer.  Much anxiety to the person bitten and to his friends would be avoided if these rules were observed, because in many cases it will be shown that the animal did not after all suffer from rabies, and that the patient consequently runs no risk.  If, on the other hand, rabies is proved to be present, the patient should be submitted to the Pasteur treatment.