ON HYDROPHOBIA, AND MEANS SUGGESTED FOR ITS TREATMENT.

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quantity of blood is admitted into its cavities, thus ac- with even a moderate hope of success. Of its pathology littles counting for the smallness as well as the frequency of the or nothing is known, while there is scarcely a drug in the pulse. The action at the same time is generally irregular materia medica but has been tried, and found either useless also. This is observed in the strongest subjects, as well as in or at moet but temporarily beneficial, many to the weakest. The disease, when it has once taken place, hasten the fatal termination. Pages might be filled with deleaves the organ disposed to a recurrence of the malady ever scriptions of the various means successively vaunted as infalafterwards, and which is characterized by the same train of lible, even within these last few years. Not long ago, several cases were published by a French surgeon, who described his symptoms as before. The principal object I had in view in the present paper was, patients as placed in hot air baths, the temperature of which to show that such cases, though attended by the characters was increased to 2000 Fahr., and upwards. Profuse perspiramentioned-namely, smallness and feebleness of pulse, with tion and subsequent recovery was said to have followed in the usual feelings of anxiety and depression, nevertheless all, excepting in one, a boy, who died while in the bath. admit of, and, indeed, imperatively demand, the same general It was observed at this time, as a curious pathological fact, principles of treatment that are applicable to inflammation in that the only animals in which hydrophobia appears spontageneral, but in an especial manner the use of the lancet, in neously, are those which do not perspire by the skin, as the comparison with which all other means are of trifling moment. dog, fox, or jackal; it is said also to have appeared in the cat. But while I speak thus positively on the subject, it is of Then again, it was asserted that certain enlarged veins’ importance to observe, that the peculiar and impeded state of were to be found under the tongue, which, if punctured in an the general circulation calls for extreme caution and reserve early stage of the disease, invariably stopped its further proin the application of the chief means of cure. In regard to gress. Drowning the patient in salt water, and recovering the abstraction of blood in such cases, ounces may be con- him by the usual means, has also been recommended; but these sidered as equivalent to pounds in others. A large and and many other remedies, although they excited some attensudden abstraction of blood, where the heart is the part in- tion at the time they were promulgated, seem to have been flamed, (especially if fainting should ensue,) might, not im- forgotten, or, if tried, either to have proved inefficient, or to probably, prove instantly fatal. The quantity of blood drawn have terminated the malady by killing the sufferer outright. at once should be from two or three to five or six ounces, as The last has, indeed, been done purposely, within the memory before stated, and it should be taken in the recumbent posture, of many, by smothering between feather beds, bleeding to and rather slowly than rapidly, for the purpose of avoiding death, or the administration of poison. The production of asphyxia by the introduction of the fainting. By proceeding in this cautious way, nothing but good is Wourali poison into the system, through a wound, has been likely to result; and this I venture to say upon the ground of practised on animals, which have been recovered by artificial A frequent repe- respiration, and this process has been recommended in hydrono inconsiderable experience of such cases. tition of the same remedy, however, at short intervals, will phobia, by high authorities, but the experiment, I believe, reprobably be required, to give a chance of lasting benefit. mains to be tried on the human subject. Then it has been The advantages gained by this way of proceeding are, in a advised by Magendie and others, to inject large quantities of large proportion of instances, prompt and unequivocal, espe- warm water into the veins, after bleeding, and this has been case has not been too long neglected. There followed by decided, although but temporary benefit: and cially where the generally, immediate and considerable relief experienced, lastly, we have the inhalation of ether, as practised in the case is, in regard to the most distressing symptoms; the sleep is of the Indian boy, Ramjan. Taking into consideration the rendered more refreshing; the pulse acquires more of regu- effects produced bv these two last methods of treatment. I am larity and apparent force, and the appetite is generally im- induced to propose the following plan as at least worthy of a proved ; and as food may be freely taken, according to the appe- trial: In the first place, endeavour to unload the bowels by tite without any great nicety as to choice, the body is better powerful cathartics, assisting their operation with anti-spasnourished, and the strength recruited, under what is commonly modic and purgative enemata, and if the patient does not considered a debilitating plan of treatment. I could cite resist, promote the function of the skin by immersion in the numerous instances, from my own experience, of the prolonga- hot water, or vapour bath. Then let him inhale ether until tion of life for many years, and not a few of complete reco- its effects are fully produced, when the enema might, if necesvery, from a treatment of this kind, the object being the slow sary, be repeated, and the body sponged with warm water, if and gradual removal of the inflammation, which is the real the bath has not been used. While etherization continues, disease. take, from a moderate-sized opening in the arm, as much With respect to other auxiliary means, though of small com- blood as the patient can possibly bear to lose, without actually parative importance, they ought not to be wholly neglected. endangering his life from this cause, and immediately, with Amongst these, I would mention, as first in importance, the an appropriate apparatus, inject into the orifice fresh blood, digitalis, for the purpose of lessening somewhat the frequency lowing from the veins ofaperfectly healthy person, if possible of of the heart’s action. For this object, only small doses are the same sex, age, and constitution as the patient, and to about required, or even admissible, as from eight to ten drops of the half or two-thirds of the quantity the latter has been deprived tincture, given three or four times daily, and continued only of: this should be done with the greatest care and gentleness, for a few days at a time. Counter action, also, of a mild attending carefully to the directions laid down for the operadescription, such as will not materially irritate or disturb the tion of transfusion, as described by various obstetric and other general health, will be desirable. In addition to these means, writers, in the treatment of excessive haemorrhage, and bearwhich, I believe, include all that is of real utility in such cases, ing in mind, that if air finds its way into the veins, speedy it is of undoubted importance, in regard to the common cir- death inevitably follows. On the restoration of the patient cumstances of life, to avoid cautiously whatever is calculated to consciousness, he should be encouraged to eat heartily, and to excite or disturb the general circulation. the free action of the organs of excretion should be kept up London, June, 1848. by proper medicines. Should the paroxysms return, the whole treatment might be repeated, although the medical attendant would be guided in a great measure by the natureof the case, ON HYDROPHOBIA, AND MEANS SUGGESTED and the results of the previous operation. This practice might be pursued at any stage of the disease, FOR ITS TREATMENT. although few would feel justified in resorting to it, unless unBY CHARLES COBBE, Esq., M.R.C.S.E., Kensington. doubted premonitory symptoms had appeared. I may add that I have practised transfusion on the lower AMONGST the various diseases in which the inhalation of ether is likely to prove beneficial, hydrophobia, from the nature of animals, frequently, with various results, many having lived its symptoms, is one in which its use appears to be particularly for some time after being subjected to this operation, when indicated, and we are much indebted to Mr. Robert Allan for poison had been previously introduced into the system. Bedford.place, Kensington, October, 1847. his interesting case, published in THE LANCET, of October 16th last. Happily for the human race, this dreadful and hitherto incurable malady is comparatively rare, and consequently the ROYAL HOSPITAL FOR THE WOUNDED.—The palace of theopportunities afforded us far observing the effects of any new remedies that may be proposed are but few. Nevertheless, Tuileries, which after the 24th of February had been transnumerous cases have been reported from time to time, and formed into an hospital for the wounded, is to be cleared of

small

appearing

,

we have had the same ness over and over

from the

symptoms described with great minute- the remaining sick. The convalescent will be

again, yet are we nearly as far off as

knowledge

cf any treatment to which

we can

ever

look

sent to certain those who have not reached the stage of’ convalescence will be placed in some of the Paris hospitals.

watering-places;