The GEN. I. SPEC. VIII. The E. Lyssa canina. Canine disease. Range of Singular extension of intervals. did not essentially vary from those just related. local indications mostly but not always preceded. interval between the bite inflicted by the rabid wolf, and the access of disease, varied from a fortnight to five weeks, rabies. and the patients uniformly sunk on the second or third Ordinary day after a clear developement of the symptoms. In interval. the preceding year, however, M. Trolliet had a case produced by the bite of a mad dog, in which the disease did not show itself till five months and a half after the infliction of the wound. The patient was a strong, robust man, of thirty years of age, and the dog had died mad in the veterinary school at Lyons soon after the injury. The first symptoms in this case were the usual ones of pain in the bitten part, which gradually extended to the arm and neck. Two days afterwards the patient was sensible of a vapour or aura which ascended from the abdomen to the head accompanied with a general uneasiness. The symptom of hydrophobia was manifested on the day ensuing; the depleting plan was, in this instance, followed up with a daring urgency, and the man expired on the evening of the same day. examina M. Trolliet's post-obit examinations are numerous, and Post-obit they uniformly give proof, like the dissections already tions. noticed, of extensive mischief in various organs remotely situated from each other; the chief of which, however, were the mucous membrane of the trachea and bronchiæ, and the membranes of the brain, especially the pia mater; all which, in direct repugnance to M. Magendie's observations, were infiltrated with red blood, and gave evident proofs of inflammatory action; while the mucous membrane of the bronchiæ and trachea were covered over with a frothy material of a peculiar kind, which M. Trolliet supposes to be the seat or vehicle of the specific virus, and which in his opinion is driven forward into the fauces and intermixed with the saliva by each spastic expiration from the chest. The other organs he found affected as follows: the capillary vessels of the lungs were penetrated with a larger quantity of blood than ordinarily; their substance was emphysematous, or contained an ac GEN. L. SPEC. VIII. canina. Canine Rabies. cumulation of air; as did also the heart and large blood B E. Lyssa vessels in some instances. The blood itself was black, uncoagulating, and of an oily appearance. That taken from the veins during the disease coagulated into an entire cake without any separation of serum. The mucous membrane of the mouth and pharynx were of a pale grey and lubricated by a gentle moisture; they contained no saliva nor any frothy material. The most singular fact of the whole is that "the salivary glands and the cellular substance which envelopes them, afforded not the least vestige of inflammation; nor the slightest alteration in their volume, their colour, or their texture." Trolliet's hypothesis mate cause of lyssa. It is this last circumstance that seems chiefly to have of the proxi- induced M. Trolliet to venture upon a new hypothesis, and to suppose that the actual seat of the specific virus is the mucous membrane of the bronchiæ or lower part of the trachea, rather than the fauces or the salivary glands; and had these last in every instance been discovered as clear of any manifest morbid appearance as in the dissections of this ingenious pathologist, there would be strong ground for his conjecture: but, as we have already seen that in some cases there have been found only slight marks of inflammatory action in the bronchiæ, while the fauces and esophagus, and occasionally the stomach and even the ileus have been so inflamed as to approach a state of gangrene, much further investigation is necessary before the old doctrine should fall a sacrifice to the new. only fact we are at present able to collect from dissections, is a very extensive and violent disturbance throughout the entire frame; sometimes fastening chiefly on one set of organs, and sometimes on another. Medical treatment of the disease, when it appears, altogether unsettled. tic course The The mode of TREATMENT is a field still perfectly open for trial; for at this moment we have no specific remedy nor any plan that can be depended upon, after the disease shows itself. Antecedently, indeed, to this period our course is obProphylac- vious, and particularly if we should be so fortunate as to be consulted at the time of the bite: and should consist in endeavouring, by the promptest and most efficacious obvious. The bitten part to be destroyed. SPEC. VIII. Rabies. Prophylac Various means, to prevent the spread of the disease, by washing GEN. I. the part well and thoroughly at the nearest spring or Entasia river at hand, and by extirpating the virus before absorp- Lyssa. tion has taken place. This has been done in various ways: for the lacerated part has been sometimes ampu- tic treattated or dissected; and at other times totally destroyed by the actual or potential cautery. The actual cautery, modes proby the means of irons heated to whiteness, was first adopt posed. ed and recommended by Dioscorides, and afterwards by Van Helmont, Morgagni †, and Stahl: the potential cautery seems to have been proposed as a less terrific mode of operation, and has usually been accomplished by the means of lapis infernalis or decarbonated soda. It is recommended by Schenck, Pouteau, and Dr. Moseley. A notion, however, has obtained from a very early period that the irritation produced by a cautery, whether actual or potential, only increases the tendency to absorption : and Trampel has endeavoured to prove this: on which account Hildanus and Morgagni have advised excision in combination with the cautery: the former proposing to cut out the eschar as soon as it is formed, without letting it remain for a spontaneous separation; and the latter, far more effectually, recommending that inustion should follow the application of the knife instead of preceding it. cautery not to be de Of these three modes of operating, the potential cau- Potential tery is least entitled to be depended upon, for it is not sufficiently rapid in its action. Of the other two it is, pended perhaps, of little consequence which is selected, and upon. either of them will generally prove sufficiently efficacious alone, if employed early enough to anticipate absorption, and extensively enough to make sure of extirpating or destroying every portion of the bitten part. There is reason to believe that in many instances this has not been done, so that Camerarius places as little confidence in the actual cautery as in the potential; and Dr. Hamilton . Lib. VI. GEN. I. SPEC. VIII. Entasia Lyssa. Rabies. Prophylactic treatment. Excision and actual cautery to be employed jointly. A tight ligature to be applied where the parts will admit. Its benefit from analogy. Practice loose and apparently incongru ous when the constitutional symptoms appear. almost as little in excision. And hence, another reason for employing both means in the manner recommended by Morgagni; in which case we shall find it unnecessary to superadd any of those irritant, exulcerant, or suppurative applications which have been employed by many practitioners with a view of introducing a fresh local action, and maintaining a fresh local discharge, and which have chiefly consisted of cantharides, camphor, alliaceous cataplasms, resins, turpentine, or, as Celsus recommends, culinary salt *. It may likewise be adviseable, as proposed by Sir Kenelm Digby, and since his time by Dr. Haygarth, to wash the wound again thoroughly with tepid water, or tepid wine and water, before the excision is commenced. M. Portal, however, thinks, the application of the cautery, whether actual or potential, may be serviceable long after the wound has been inflicted, and even after it has healed, though he advises its use as early as possible +. There is also another, and a very easy, and perhaps a very salutary operation, which I would strenuously recommend from the first, even before the process of ablution. I mean that of applying a tight ligature to the affected part wherever it will admit of such an application, at a short distance above the laceration. I have never had an opportunity of trying the benefit of such a measure in my own practice; but analogy is altogether in its favour, for it is well known to be one of the most important steps we can take in confining the poisonous effects of the rattlesnake, and other venomous animals, and of mitigating its violence by the torpor which follows; and it has the sanction of many authorities of deserved credit, as Hacquet, Percival, Vater, Wedel, and Trolliet. If, however, the local plan should prove ineffectual, our curative practice, as already observed, is still unfortunately all afloat, and we have neither helm to steer by, * De Medicinâ, Lib. v. Cap. xxvii. § 1. + Mémoires sur la Nature et la Traitement de plusieurs Maladies. Tom. IV. 8vo. Paris, 1819. GEN. I. SPEC. VIII. Rabies. nor compass to direct our course. There is, indeed, no disease for which so many remedies have been devised, and none in which the mortifying character of vanity of Lyssa. vanities has been so strikingly written on all of them. In Remedial the loose and heterogeneous manner in which they have treatment. descended to us, they seem indeed to have followed upon one another without rational aim or intention of any kind. Yet, if we nicely criticise and arrange them, we shall find that this is not the case. There are four principles by which physicians appear to have been guided in their respective attentions to this disease. That of stimulating and supporting the vital power so as to enable it to obtain a triumph in the severe conflict to which it is exposed. That of suddenly exhausting the system by severe bleedings and purgatives, as believing the disease to be of a highly inflammatory character. That of opposing the poison by the usual antidotes and specifics to which other animal poisons were supposed to yield. And that of regarding the disease as a nervous or spasmodic, instead of an inflammatory, affection, and, consequently, as most successfully to be attacked by an antispasmodic course of medicines and regimen. Summary of the com mon intent tions of cure. First intenstimulate and support tion: to the vital power. The very popular use of volatile alkali and camphor, may, by some, be ascribed to the first of these views, as being powerful stimulants; yet, in fact, they were rather employed from different motives, and fall within one or two of the principles of action which yet remain to be con- Volatile sidered. But to this class of medicines, designed ex- alkali. pressly to support the vital power, and enable nature herself to triumph in so severe a struggle, belong expressly the warm and cordial confections and theriacas that were at one time in almost universal estimation; as also various kinds of pepper given in great abundance, oil of cajeput, different preparations of tin, copper, and iron, and, in later periods, bark. Cordial confections and theriacas: pungent aromatics. tention: In direct opposition to this stimulating and tonic plan, Second inwas that of suddenly debilitating and exhausting the system upon the hypothesis that the symptoms of canine |