n of devitalised tissues, and
drainage of the wound are first carried out. To arrest the absorption of
toxins intra-muscular injections of 10,000 units of serum are given
daily into the muscles of the affected limb, or directly into the nerve
trunks leading from the focus of infection, in the hope of "blocking"
the nerves with antitoxin and so preventing the passage of toxins
towards the spinal cord.

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