GEN. I. SPEC. VIII. Rabies. specific influence on this organ, and is capable of aug- Treatment. Its apparent advantage in many cases into this dently asserted to have followed upon the use of mercury resolvable carried to the point of free salivation. And hence, without principle. allowing this medicine to be a specific more than any other, we may indulge a reasonable hope of its forming a good auxiliary, and should employ it freely, either externally, internally, or in both modes simultaneously; but with as little disturbance to the patient as possible, till a copious ptyalism is the result. Fever, or inflammatory action, has sometimes associated: and hence ed against to be guard aperients : times free use of Fever, or inflammatory action, does not necessarily belong to lyssa in any stage: and the present mode of treatment is altogether grounded upon this principle. Either, however, may become incidently connected with it from the peculiar state of the habit or some other cause. Hence, as a preventive, the bowels should be kept moderately open; and wherever there is any just apprehension of by gentle plethora, or a turgid state of the vessels, and particularly and someof the brain, blood should be drawn freely from the arm, and, if necessary, be repeated. We have already seen that such a state of congestion is sometimes produced even at the onset of the disease, and is so forcibly felt by the patient himself, that he earnestly intreats the medical attendant to bleed him. Such intreaty should, perhaps, of congesnever be urged in vain but the bleedings to deliquium, which have of late years been so strongly recommended, are a rash and dangerous practice, unfounded on analogy, and by no means rest on any sufficient assurance. Such, in the doubt and darkness that at present beset us, concerning the real physiology of lyssa, seems to be the safest and most promising path we can pursue, when called upon for aid in so afflictive a malady. Our best the lancet: especially when the patient intreats to be blooded from a sense tion. Importance diate process of interme upon the inthe wound. fliction of GEN. I. SPEC. VIII. Entasia Lyssa. Rabies. Treatment. Poison of viper proposed as an antidote to that of mad dog. Contagion a power of generating rabies : but not of receiving it by contact. Use to be made of this fact if true. time for action, however, and almost the only time we can improve, is immediately on the infliction of the wound: tight ligature above which, with the double precaution of excision and cauterization, may in general be regarded as an effectual preventive. I do not know, indeed, that the profession is acquainted with any other. It has, however, been proposed in France, to fight off the poison of lyssa by pre-occupying the ground with the poison of a viper, upon the principle of combating variolous with vaccine matter: and for this purpose it has been suggested that the part bitten by a mad dog should be again bitten a little below the wound, as soon as may be, by a venomous serpent, whose virus, from its greater activity, will, in most cases, be certain of taking the lead, and may, it is presumed, guard the constitution against any subsequent effects from the wound of the mad dog. I have not, however, heard that this proposal has ever been carried into effect, and the claim of ingenuity is, most probably, the whole it will ever have to receive. I ought not, however, to conclude without noticing one very extraordinary fact in the economy of morbid poisons, and especially of that before us, which I have had confirmed by the testimony of several veterinary practitioners entitled to credit. It is, that no dog who has ever had the distemper, as it is called, which is the canine catarrh or influenza, has been known to become rabid spontaneously, though he is capable of receiving the disease by the bite of another dog. If this be true, for which however I cannot fully vouch, we have certainly another instance of morbid poisons mortally conflicting with each other; and it might be worth trying how far inoculation with the matter of canine catarrh might succeed in protecting a human subject after the infliction of a rabid bite; though in the dog, perhaps from a stronger predisposition to rabies, it seems to be impotent. In facts in sup- South America, rabies, as already observed, is altogether unknown, and I have hence been anxious to learn whether the distemper be unknown there also: and, in answer to this inquiry, it has been told me, by several intelligent resi Collateral port of it. GEN. I. SPEC. VIII. dents in that quarter, that this last disorder is so common and so fatal, that two-thirds of the dogs littered there Entasia perish of it while pups: a remark which still further con- Lyssa. firms the home-report concerning its influence on rabies, Treatment. and sufficiently explains the non-existence of the latter on the shores of the Plata. Rabies. SPECIES IX. ENTASIA ACROTISMUS. Pulselessness. FAILURE, OR CESSATION OF the pulse, OFTEN ACCOM- UNDISTURBED. GEN. I ACROTISMUS is literally "defect of pulse", from xpóτos, SPEC. IX. "pulsus", with a privitive a prefixed: whence the techOrigin of nichal term crotophus or crotophium, importing "painful the specific pulsation or throbbing in the temple". Asphyxia is the term. term employed for this disease by Ploucquet, and would Asphyxia have been used in the present arrangement but that it used syhas been long appropriated to import suspended anima- nonymously. tion or apparent death; a total cessation, not of the pulse only, but of sense and voluntary motion. sometimes sometimes sometimes limited. This failure or cessation of pulsation sometimes ex- Failure of tends over the whole system, and is sometimes confined pulsation to particular parts. In every case it imports an irregu- general, larity in the action of the heart, or of the vessels that issue from it, and in most cases, an irregularity proceed- Importing ing from local or general weakness, and dependent upon debility of a spasmodic disposition hereby produced in the muscular arteries; tunic of the vessels. Of this last cause we have a clear SPEC. IX. Entasia Pulseless ness. connected with a spas modic disposition. proof in the universal chill and paleness that spread over the entire surface in the act of fainting or of death, to Acrotismus. which fainting bears so striking a resemblance. Except, however, in the agony of dying, the spasmodic constricand mostly tion for the most part soon subsides, and the arteries recover their proper freedom and diameter. Yet this is by no means the case always, for in violent hemorrhages, and especially hemorrhages of the womb, the rigidity has sometimes continued for several days, during the whole of which time the heart has seemed merely to palpitate, and Exemplified. there has been no pulse whatever. Morgagni relates, from Ramazini, a case of this kind which extended to four days. The patient was a young man of great strength and activity even during this suppression. The arteries were as pulseless as the heart: and, through the whole period he was quite cold to the touch, and without micturition. On the fourth day he died suddenly *. Examples indeed are by no means uncommon in which the spasm has existed for three †, four, or even five days before death. Other irritations than Other irritations, besides that of weakness, have occathat of weak- sionally led to a like spastic state of the arteries. ness are sometimes causes. The stimulus of an aneurism of the aorta has produced it in the brachial arteries, so that there has been no pulse in the wrists and gout or some acrimony in the stomach has operated in like manner on the arterial system to a much greater extent: as has likewise general pressure on the larger thoracic or abdominal organs, from water in the chest or cavity of the peritoneum. The cause, however, is not always to be traced, and hence Marcellus Sometimes Donatus has given an instance which he tells us was unaccompanied with any disease whatever §; the irritation probably having subsided. Berryatt, in the History of the Academy of Sciences, has furnished us with a very singular example of this disease which was general as well as chronic, and continued through the whole term of life. habitual after the irritation has subsided. De Sedibus et Causis Morb. Ep. XLVIII. Lugd. Bat. 4to. 1767. + Pathology, p. 25. § Lib. VI. cap. I. p. 620. | Pelargus, Med. Jahngange. Band. v. p. 23. any case GEN. I. SPEC. IX. Acrotismus. Pulseless attended through the In all which cases the heart prothough inbably beats, distinctly. Great re tardation of In all which cases, however, though the heart itself should seem to participate in the pulselessness, we are not to Entasia suppose that it is entirely without any alternation of systole and diastole, but only that its action is indistinct ness. from weakness or irregularity. In treating of the nature Hence has of the pulse in the Physiological Proem to the third class, we observed that it is in some persons unusually slow, whole of a and has been found, as measured by the finger, not more long life. than ten strokes in a minute *: and that in many of these cases the cause of retardation seems to be a spasticity or want of pliancy in the muscular fibres of the heart or arteries, or both, rather than an actual torpor which is also an occasional cause. I have never met with in which the ordinary standard of the pulse was not more the pulse than ten strokes in a minute; but I have at this time a patient of about thirty-six years of age, whose pulse has not exceeded twenty-four or twenty-six strokes, and has often been below these numbers. He is a captain in the Royal Navy, of a sallow complexion and bilious temperament; till of late he enjoyed good health, but about Exemplified. three years since was attacked with a fit of atonic apoplexy from which he recovered with difficulty. At an interval of a few weeks from each other, he had several other fits; on recovering from the last of which he instantly married a young lady to whom he had for some time been engaged. He has now been married about fifteen months, has a healthy infant just born, and has had no fit whatever. His spirits are good, and he is residing by the sea-side, which situation he finds agree with him best. not uncommon, sometimes amounting to only ten strokes in a minute. Dr. Latham gives a similar example in a merchant whose pulse, though never intermissive, seldom, for ten or twelve years that he had known him, exceeded thirty-two beats in a minute; occasionally was as slow as twenty-two, and at one time only seventeen. "I once", says Dr. Latham," attended him through a regular fever, when his Further pulse was not more than sixty, notwithstanding the disease ran on for at least a fortnight with a hot and dry *Vol. 11. p. 21. illustration. |