GEN. I. SPEC. VIII. Entasia Lyssa. Rabies. rabies were those of violent and rapid inflammation. The practice of applying ice or the coldest water to the head, and of submersion in cold water, belongs mostly to this view of the subject, as used a century ago, though in the time of Celsus, it was employed in a much slighter to take off degree to take off the spasm of hydrophobia, and to supposed inflamma Remedial treatment. tory action. Submersion in cold water: recom mended by Celsus. To be succeeded by a bath of warm oil. Cold submersion in perilous extreme. Illustrated. quench the thirst that accompanied it. "Miserrimum genus morbi; in quo simul æger, et siti et aquæ metu cruciatur: quo oppressis in angusto spes est." * In this almost hopeless state, the only remedy (unicum remedium) Celsus continues, is to throw the patient instantly and without warning, into a fish-pond; alternately, if he have no knowledge of swimming, plunging him under the water that he may drink, then raising his head, or forcing him under it if he can swim, and keeping him below till he is filled with the water; so that the thirst and water-dread may be extinguished at the same time. But there is here, continues our author, another danger, lest the body of the patient, exhausted and worn out by the submersion as well as by the disease, be thrown into convulsions to prevent which, as soon as he is taken out of the pond, he is to be put into warm oil †. The bolder practitioners of subsequent times, in pursulater times ing the refrigerating plan, were regardless of convulsions, carried to a and persevered at all hazards in reducing the living power to its last ebb; believing that the nearer they suffocated the patient without actually killing him, the greater their chance of success. Hence Van Helmont kept the wretched sufferer under water till the Psalm "Miserere" was sung throughout, which, under some choristers, occupied a much longer time than under others; and in the experiments of the Members of the Academie Royale, we meet with instances of a still more dangerous pertinacity; though success is said to have accompanied one or two of them. Thus, M. Morin relates the case of a young woman, twenty years old, who, labouring under symptoms of hydrophobia, was plunged into a tub of water with a bushel De Medicina. Lib. v. Cap. xxvii. § 2. + Cels. loco citato. GEN. I. SPEC. VIII. Rabies. of salt dissolved in it, and was harassed with repeated dippings till she became insensible and was at the point Entasia of death, when she was still left in the tub sitting against Lyssa. its sides. In this state, we are told, she was at length Remedial fortunate enough to recover her senses; when much to treatment. her own astonishment, as well as to that of the by-standers, Second inshe found herself capable of looking at the water, and even of drinking it without choking*. With respect to the warm oil-bath which Celsus recommends in succession to that of cold water, the present author can say that, in a single instance to which he was a witness when a young man, it produced no benefit whatever. It was prescribed by a physician in consequence of the recommendation of Celsus, but who certainly had not read him attentively, nor was acquainted with the scope of his reasoning. For in this case cold bathing had not been tried antecedently, and consequently there was no danger of those convulsions for which alone the Roman physician enjoins the use of the oil. The experiment, however, was so far perfect, that the tub was full of oil and deep enough to reach the patient's chin. tention. Warm oil bath of no service. In connexion with the cold-bath thus persevered in to Drastic suffocation, the reducent or antiphlogistic plan was still purgatives. farther forwarded, at one time, by the use of strong drastic purgatives, of which colocynth was, for a long nesections. period, the favourite †; and at other times by a very bold Profuse veand perilous use of the lancet. Bleeding has lately been revived and carried to the extent of deliquium by large and rapid depletions, and the operation has been repeated almost as long as the powers of life would allow. Dr. Nugent employed it at Bath, in 1753, in one case, and the patient was restored, but musk and other antispasmodics were largely employed at the same time; and Dr. Shoolbred of Bengal has since had two patients who recovered under this process; but he employed mercury at the same time, and it is by no means certain either from the history of the patients, or of the Hist. de l'Acadamie Royale, Ann. 1709. + Hellot, An de Morsis à Rabido Colocynthis? Paris, 1676. Revived in the present day: GEN. I. dog by which they were bitten, that the disease was a genuine lyssa. SPEC. VIII. Entasia Lyssa. Remedial treatment. Second intention. Yet whatever benefit this practice may possess, it has no pretensions to novelty: for there is not a single course of treatment ever invented for this intractable disease that has been for upwards of a century more extensively tried and retried, both moderately and profusely, or excited a warmer controversy upon its merits. Pou Exemplified. part, in 1699, espoused the practice, and gives the case of a woman, who perfectly recovered by bleeding her to deliquium, and afterwards confining her for a year to bread and water *. without any pretensions to novelty. Berger, in the same year, recommended bleeding, but advised that the blood should be taken from the forehead. In the Breslaw Collections for 1719, is the case of a cow supposed to be rabid and said to be cured by profuse bleeding. And the Philosophical Transactions abound with similar histories, some of them purporting to have been attended with similar success, derived from human subjects: but most of them too loosely given or too indecided in their symptoms to be in any measure entitled to reliance. That of Dr. Hartley and Mr. Sandys was, at one time, appealed to as demonstrative. It is the case of a groom who was bitten by a dog, supposed to be mad, towards the end of November, and who sickened about the middle of January ensuing; he had an aversion to drink, and was conjectured to be labouring under rabies. Venesection was here trusted to almost entirely, and every repetition of the lancet seemed serviceable: in consequence of which he lost a hundred and twenty ounces of blood in the course of a week, by different depletions, which consisted of sixteen or twenty ounces at each time. The man recovered: but few readers will believe him to have been really rabid when they learn that although he had an aversion to drink, he swallowed liquids that his chief symptoms were sickness, trepidation, a faultering speech and memory; and that, through Hist. de l'Acadamie des Sciences. An. 1709. the whole course of the disease, he attended, though with some difficulty, to his duty in the stable *. GEN. I. SPEC. VIII. Lyssa. Rabies. Second in tention. The Edinburgh Medical Commentaries are equally replete with cases in which the same plan of evacuation had been tried, but they are also equally unsatisfactory. treatment. Thus, Dr. Tilton informs us that, having heard of the recovery of a patient from the disease before us, who had Additional bled profusely and almost to death, by an accidental fall instances. from a high place, and a division of the temporal artery, he employed venesection freely in a case of his own, drawing off from twenty to thirty ounces at a time, and occasionally bleeding to deliquium +. But the symptoms are here also so doubtful that the result is of no importance. Failure of the practice proved from its disconti nuance and The practice, therefore, has been not uncommon for at least a century and a half; and had it proved as specific as some late reports would induce us to believe, it must have descended to us with a wider and more confirmed specific facts. reputation, and formed the only course to be relied on. But the misfortune is that, however salutary at times, it has often completely failed in the hands of unprejudiced and judicious practitioners; and where it has succeeded it has generally been combined with other means that have been resorted to at the same time. There is a case of failure related by Dr. Plummer in the Edinburgh Medical Essays‡: but it is not much to be relied on, as not more than twenty ounces of blood were lost at a second and accidental bleeding, and only ten a day or two before by a prescribed venesection. Mr. Peters, however, who employed profuse and repeated bleedings, sometimes even to deliquium, had, in his day, so little dependence on them alone, that he uniformly combined this remedy with opium and mithridate, or other cordials, and in the case which he has introduced into the Philosophical Transactions, he ascribes the success which accompanied his plan to this combined mode of treatment §. In like Additional examples. GEN. I. SPEC. VIII. Lyssa. Remedial treatment. Second intention. Failure proved upon dogs by Magendie and and others. And abundantly proved upon the human subject by Trolliet. And the more profuse the bleeding the sooner a fatal issue. manner, Mauchart, as quoted by Bühlmeier, while he advises bleeding, and to an extent proportioned to the length of the interval between the infliction of the wound and the attack of the paroxysm (and where the patient is of a melancholy temperament, even to deliquium), advises, at the same time, that the bitten part be scarified; and when this also has bled till nothing but serum escapes, that the wound be dressed with mithridate, theriaca, or rue, and a defensive plaster put over it, and that the patient take pills, compounded of mithridate and other materials, to the number of nine every day for nine months, keeping himself in a free perspiration, and cautiously changing his linen. In the case of dogs, venesection, how liberally soever made use of, does not seem to be of much benefit. It has lately been the subject of a series of experiments at Paris, under the superintendence of MM. Magendie, Dupuytren, and Breschet, who have carried it to deliquium, but without any success whatever. And hence, though it has unquestionably been serviceable, in many cases, the practice cannot be regarded as a specific. To close the whole, Professor Trolliet has employed venesection so extensively, and in such variable proportions, from single or double bleedings of sixteen ounces each to not less than seven pounds, by different bleedings in the course of a few hours, and in every instance so entirely without effect, as reasonably to put the question at rest for ever. And the more so as, in his hands, the bolder the practice the sooner the patient fell a sacrifice to it. We have a striking example of this in the case of the patient just referred to, whose interval between the infliction of the wound and the signs of the disease extended to upwards of five months. Early on the morning in which the hydrophobia first appeared, blood-letting to syncope was prescribed, and five pounds were drawn off before this effect was produced. The water-dread returned with the return of recollection; and at eleven o'clock on the same morning he was again blooded to the amount of eighteen ounces, when he again fainted. The |