OBSERVATIONSUPONTHE NATURE AND CUREOF THEHYDROPHOBIA.

Footnotes:[58]VolumeIV.[59]Medical Memoirs, vol. III.[60]Medical Reports on the Effects of Hot and Cold Water, p. 215.[61]Defence of Blood-letting, vol. IV.[62]Medical Observations and Inquiries, vol VI. p. 201.[63]Physical and Literary Essays, vol. III. p. 469.[64]Defence of Blood-letting.[65]Medical Observations and Inquiries, vol. vi. p. 220.[66]Essay upon the Cure of the Gout by Moxa, vol. i. folio edition, p. 143 and 141.[67]Medical Observations and Inquiries, vol. vi. p. 220.[68]Medical Memoirs, vol. III.[69]Observat. Chirurg. Cent. 1. Obs. 79.[70]Essay on the Nature and True Method of Treating the Gout, p. 36.[71]Page30.[72]Essay on the Nature, and True Method of Treating the Gout, p. 69.[73]Morborum Chronicorum. Lib. v. Cap. 2.

Footnotes:

[58]VolumeIV.

[59]Medical Memoirs, vol. III.

[60]Medical Reports on the Effects of Hot and Cold Water, p. 215.

[61]Defence of Blood-letting, vol. IV.

[62]Medical Observations and Inquiries, vol VI. p. 201.

[63]Physical and Literary Essays, vol. III. p. 469.

[64]Defence of Blood-letting.

[65]Medical Observations and Inquiries, vol. vi. p. 220.

[66]Essay upon the Cure of the Gout by Moxa, vol. i. folio edition, p. 143 and 141.

[67]Medical Observations and Inquiries, vol. vi. p. 220.

[68]Medical Memoirs, vol. III.

[69]Observat. Chirurg. Cent. 1. Obs. 79.

[70]Essay on the Nature and True Method of Treating the Gout, p. 36.

[71]Page30.

[72]Essay on the Nature, and True Method of Treating the Gout, p. 69.

[73]Morborum Chronicorum. Lib. v. Cap. 2.

In entering upon the consideration of this formidable disease, I feel myself under an involuntary impression, somewhat like that which was produced by the order the king of Syria gave to his captains when he was conducting them to battle: “Fight not with small or great, save only with the king of Israel[74].” In whatever light we contemplate the hydrophobia, it may be considered as pre-eminent in power and mortality, over all other diseases.

It is now many years since the distress and horror excited by it, both in patients and their friends, led me with great solicitude to investigate its nature. I have at length satisfied myself with a theoryof it, which, I hope, will lead to a rational and successful mode of treating it.

For a history of the symptoms of the disease, and many interesting facts connected with it, I beg leave to refer the reader to Dr. Mease's learned and ingenious inaugural dissertation, published in the year 1792.

The remote and exciting causes of the hydrophobia are as follow:

1. The bite of a rabid animal. Wolves, foxes, cats, as well as dogs, impart the disease. It has been said that blood must be drawn in order to produce it, but I have heard of a case in Lancaster county, in Pennsylvania, in which a severe contusion, by the teeth of the rabid animal, without the effusion of a drop of red blood, excited the disease. Happily for mankind, it cannot be communicated by blood, or saliva falling upon sound parts of the body. In Maryland, the negroes eat with safety the flesh of hogs that have perished from the bite of mad dogs; and I have heard of the milk of a cow, at Chestertown, in the same state, having been used without any inconvenience by a whole family, on the very day in which she was affected by this disease, and which killed her in a few hours.Dr. Baumgarten confirms these facts by saying, that “the flesh and milk of rabid animals have been eaten with perfect impunity[75].”

In the following observations I shall confine myself chiefly to the treatment of the hydrophobia which arises from the bite of a rabid animal, but I shall add in this place a short account of all its other causes.

2. Cold night air. Dr. Arthaud, late president of the society of Philadelphians in St. Domingo, has published several cases in which it was produced in negroes by sleeping all night in the open air.

3. A wound in a tendinous part.

4. Putrid and impure animal food.

5. Worms.

6. Eating beech nuts.

7. Great thirst.

8. Exposure to intense heat.

9. Drinking cold water when the body was very much heated.

10. A fall.

11. Fear.

12. Hysteria.

13. Epilepsy.

14. Tetanus.

15. Hydrocephalus. Of the presence of hydrophobia in the hydrocephalic state of fever, there have been several instances in Philadelphia.

16. An inflammation of the stomach.

17. The dysentery.

18. The typhus fever. Dr. Trotter mentions the hydrophobia as a symptom which frequently occurred in the typhus state of fever in the British navy[76].

19. It is taken notice of likewise in a putrid fever by Dr. Coste[77]; and Dr. Griffitts observed it in a high degree in a young lady who died of the yellow fever, in 1793.

20. The bite of an angry, but not a diseased animal.

21. An involuntary association of ideas.

Cases of spontaneous hydrophobia from all the above causes are to be met with in practical writers, and of most of them in M. Audry's learned work, entitled, “Recherches sur la Rage.”

The dread of water, from which this disease derives its name, has five distinct grades. 1. It cannot be drunken. 2. It cannot be touched. 3. The sound of it pouring from one vessel to another, 4. the sight of it, and 5. even the naming of it, cannot be borne, without exciting convulsions. But this symptom is not a universal one. Dr. Mead mentions three cases in which there was no dread of water, in persons who received the disease from the bite of a rabid animal. It is unfortunate forthis disease, as well as many others, that a single symptom should impose names upon them. In the present instance it has done great harm, by fixing the attention of physicians so exclusively upon the dread of water which occurs in it, that they have in a great measure overlooked every other circumstance which belongs to the disease. The theory of the hydrophobia, which an examination of its causes, symptoms, and accidental cures, with all the industry I was capable of, has led me to adopt, is, that it is amalignant state of fever. My reasons for this opinion are as follow:

1. The disease in all rabid animals is a fever. This is obvious in dogs who are most subject to it. It is induced in them by the usual causes of fever, such as scanty or putrid aliment[78], extreme cold, and the sudden action of heat upon their bodies. Proofs of its being derived from each of the above causes are to be met with in most of the authors who have written upon it. The animal matters which are rendered morbid by the action of theabove causes upon them, are determined to the saliva, in which a change seems to be induced, similar to that which takes place in the perspirable matter of the human species from the operation of similar causes upon it. This matter, it is well known, is the remote cause of the jail fever. No wonder the saliva of a dog should produce a disease of the same kind, after being vitiated by the same causes, and thereby disposed to produce the same effects.

2. The disease called canine madness, prevails occasionally among dogs at those times in which malignant fevers are epidemic. This will not surprise those persons who have been accustomed to observe the prevalence of the influenza and bilious fevers among other domestic animals at a time when they are epidemic among the human species.

3. Dogs, when they are said to be mad, exhibit the usual symptoms of fever, such as a want of appetite, great heat, a dull, fierce, red, or watery eye, indisposition to motion, sleepiness, delirium, and madness. The symptom of madness is far from being universal, and hence many dogs are diseased and die with this malignant fever, that are inoffensive, and instead of biting, continue to fawn upon their masters. Nor is the disposition of the feverto communicate itself by infection universal among dogs any more than the same fever in the human species, and this I suppose to be one reason why many people are bitten by what are called mad dogs, who never suffer any inconvenience from it.

4. A dissection of a dog, by Dr. Cooper, that died with this fever, exhibited all the usual marks of inflammation and effusion which take place in common malignant fevers. I shall in another place mention a fifth argument in favour of the disease in dogs being a malignant fever, from the efficacy of one of the most powerful remedies in that state of fever, having cured it in two instances.

II. The disease produced in the human species by the bite of a rabid animal, is amalignantfever. This appears first from its symptoms. These, as recorded by Aurelian, Mead, Fothergill, Plummer, Arnold, Baumgarten, and Morgagni, are chills, great heat, thirst, nausea, a burning sensation in the stomach, vomiting, costiveness; a small, quick, tense, irregular, intermitting, natural, or slow pulse; a cool skin, great sensibility to cold air, partial cold and clammy sweats on the hands, or sweats accompanied with a warm skin diffused all over the body, difficulty of breathing, sighing, restlessness, hiccup, giddiness, head-ach, delirium, coma, false vision,dilatation of the pupils, dulness of sight, blindness, glandular swellings, heat of urine, priapism, palpitation of the heart, and convulsions. I know that there are cases of hydrophobia upon record, in which there is said to be a total absence of fever. The same thing has been said of the plague. In both cases the supposed absence of fever is the effect of stimulus acting upon the blood-vessels with so much force as to suspend morbid action in them. By abstracting a part of this stimulus, a fever is excited, which soon discovers itself in the pulse and on the skin, and frequently in pains in every part of the body. The dread of water, and the great sensibility of the system to cold air, are said to give a specific character to the hydrophobia; but the former symptom, it has been often seen, occurs in diseases from other causes, and the latter has been frequently observed in the yellow fever. It is no more extraordinary that a fever excited by the bite of a rabid animal should excite a dread of water, than that fevers from other causes should produce aversion from certain aliments, from light, and from sounds of all kinds; nor is it any more a departure from the known laws of stimulants, that the saliva of a mad dog should affect the fauces, than that mercury should affect the salivary glands. Both stimuli appear to act in a specific manner.

2. The hydrophobia partakes of the character of a malignant fever, in appearing at different intervals from the time in which the infection is received into the body. These intervals are from one day to five or six months. The small-pox shows itself in intervals from eight to twenty days, and the plague and yellow fever from the moment in which the miasmata are inhaled, to nearly the same distance of time. This latitude in the periods at which infectious and contagious matters are brought into action in the body, must be resolved into the influence which the season of the year, the habits of the patients, and the passion of fear have upon them.

Where the interval between the time of being bitten, and the appearance of a dread of water, exceeds five or six months, it is probable it may be occasioned by a disease derived from another cause. Such a person is predisposed in common with other people to all the diseases of which the hydrophobia is a symptom. The recollection of the poisonous wound he has received, and its usual consequences, is seldom absent from his mind for months or years. A fever, or an affection of his nerves from their most common causes, cannot fail of exciting in him apprehensions of the diseasewhich usually follows the accident to which he has been exposed. His fears are then let loose upon his system, and produce in a short time a dread of water which appears to be wholly unconnected with the bite of a rabid animal. Similar instances of the effects of fear upon the human body are to be met with in books of medicine. The pains produced by fear acting upon the imagination in supposed venereal infections, are as real and severe as they are in the worst state of that disease.

3. Blood drawn in the hydrophobia exhibits the same appearances which have been remarked in malignant fevers. In Mr. Bellamy, the gentleman whose case is so minutely related by Dr. Fothergill, the blood discovered with “slight traces of size,serumremarkablyyellow.” It was uncommonly sizy in a boy of Mr. George Oakley whom I saw, and bled for the first time, on the fourth day of his disease, in the beginning of the year 1797. His pulse imparted to the fingers the same kind of quick and tense stroke which is common in an acute inflammatory fever. He died in convulsions the next day. He had been bitten by a mad dog on one of his temples, three weeks before he discovered any signs of indisposition. There are several other cases upon record, of the blood exhibiting, in this disease, the same appearancesas in common malignant and inflammatory fevers.

4. The hydrophobia accords exactly with malignant fevers in its duration. It generally terminates in death, according to its violence, and the habit of the patient, in the first, second, third, fourth, or fifth day, from the time of its attack, and with the same symptoms which attend the last stage of malignant fevers.

5. The body, after death from the hydrophobia, putrifies with the same rapidity that it does after death from a malignant fever in which no depletion has been used.

6. Dissections of bodies which have died of the hydrophobia, exhibit the same appearances which are observed in the bodies of persons who have perished of malignant fevers. These appearances, according to Morgagni and Tauvry[79], are marks of inflammation in the throat, œsophagus, trachea, brain, stomach, liver, and bowels. Effusions of water, and congestions of blood in the brain, large quantities of dark-coloured or black bile in the gall-bladder and stomach, mortifications in thebowels and bladder, livid spots on the surface of the body, and, above all, the arteries filled with fluid blood, and the veins nearly empty. I am aware, that two cases of death from hydrophobia are related by Dr. Vaughan, in which no appearance of disease was discovered by dissection in any part of the body. Similar appearances have occasionally been met with in persons who have died of malignant fevers. In another place I hope to prove, that we err in placing disease in inflammation, for it is one of its primary effects only, and hence, as was before remarked, it does not take place in many instances in malignant fevers, until the arteries are so far relaxed by two or three bleedings, as to be able to relieve themselves by effusing red blood into serous vessels, and thus to produce that error loci which I shall say hereafter is essential to inflammation[80]. The existence ofthis grade of action in the arteries may always be known by the presence of sizy blood, and by the more obvious and common symptoms of fever.

The remedies for hydrophobia, according to the principles I have endeavoured to establish, divide themselves naturally into two kinds.

I. Such as are proper to prevent the disease, after the infection of the rabid animal is received into the body.

II. Such as are proper to cure it when formed.

The first remedy under the first general head is, abstracting or destroying the virus, by cutting or burning out the wounded part, or by long and frequent effusions of water upon it, agreeably to the advice of Dr. Haygarth, in order to wash the saliva from it. The small-pox has been prevented, by cutting out the part in which the puncture was made in the arm with variolous matter. There is no reason why the same practice should not succeed, if used in time, in the hydrophobia. Where it has failed of success, it has probably been used after the poison has contaminated the blood. The wound should be kept open and running for several months. In this way a servant girl, who wasbitten by the same cat that bit Mr. Bellamy, is supposed by Dr. Fothergill to have escaped the disease. Dr. Weston of Jamaica believes that he prevented the disease by the same means, in two instances. Perhaps an advantage would arise from exciting a good deal of inflammation in the wound. We observe after inoculation, that the more inflamed the puncture becomes, and the greater the discharge from it, the less fever and eruption follow in the small-pox.

A second preventive is a low diet, such as has been often used with success to mitigate the plague and yellow fever. The system, in this case, bends beneath the stimulus of the morbid saliva, and thus obviates or lessens its effects at a future day.

During the use of these means to prevent the disease, the utmost care should be taken to keep up our patient's spirits, by inspiring confidence in the remedies prescribed for him.

Mercury has been used in order to prevent the disease. There are many well-attested cases upon record, of persons who have been salivated after being bitten by mad animals, in whom the disease did not show itself, but there are an equal number of cases to be met with, in which a salivation didnot prevent it. From this it would seem probable, that the saliva did not infect in the cases in which the disease was supposed to have been prevented by the mercury. At the time calomel was used to prepare the body for the small-pox, a salivation was often induced by it. The affection of the salivary glands in many instances lessened the number of pock, but I believe in no instance prevented the eruptive fever.

I shall say nothing here of the many other medicines which have been used to prevent the disease. No one of them has, I believe, done any more good, than the boasted specifics which have been used to eradicate the gout, or to procure old age. They appear to have derived their credit from some of the following circumstances accompanying the bite of the animal.

1. The animal may have been angry, but not diseased with a malignant fever such as I have described.

2. He may have been diseased, but not to such a degree as to have rendered his saliva infectious.

3. The saliva, when infectious, may have been so washed off in passing through the patient'sclothes, as not to have entered the wound made in the flesh. And

4. There may have been no predisposition in the patient to receive the fever. This is often observed in persons exposed to the plague, yellow fever, small-pox, and to the infection of the itch, and the venereal disease.

The hydrophobia, like the small-pox, generally comes on with some pain, and inflammation in the part in which the infection was infused into the body, but to this remark, as in the small-pox, there are some exceptions. As soon as the disease discovers itself, whether by pain or inflammation in the wounded part, or by any of the symptoms formerly mentioned, the first remedy indicated isblood-letting. All the facts which have been mentioned, relative to its cause, symptoms, and the appearances of the body after death, concur to enforce the use of the lancet in this disease. Its affinity to the plague and yellow fever in its force, is an additional argument in favour of that remedy. To be effectual, it should be used in the most liberal manner. The loss of 100 to 200 ounces of blood will probably be necessary in most cases to effect a cure. The pulse should govern the use of the lancet as in other states of fever, taking care not tobe imposed upon by the absence offrequencyin it, in the supposed absence of fever, and oftensionin affections of the stomach, bowels, and brain. This practice, in the extent I have recommended it, is justified not only by the theory of the disease, but by its having been used with success in the following cases.

Dr. Nugent cured a woman by two copious bleedings, and afterwards by the use of sweating and cordial medicines.

Mr. Wrightson was encouraged by Dr. Nugent's success to use the same remedies with the same happy issue in a boy of 15 years of age[81].

Mr. Falconer cured a young woman of the name of Hannah Moore, by “a copious bleeding,” and another depleting remedy to be mentioned hereafter[82]

Mr. Poupart cured a woman by bleeding until she fainted, and Mr. Berger gives an account of a number of persons being bitten by a rabid animal,all of whom died, except two who were saved by bleeding[83].

In the 40th volume of the Transactions of the Royal Society of London, there is an account of a man being cured of hydrophobia by Dr. Hartley, by the loss of 120 ounces of blood.

Dr. Tilton cured this disease in a woman in the Delaware state by very copious bleeding. The remedy was suggested to the doctor by an account taken from a London magazine of a dreadful hydrophobia being cured by an accidental and profuse hæmorrhage from the temporal artery[84].

A case is related by Dr. Innes[85], of the loss of 116 ounces of blood in seven days having cured this disease. In the patient who was the subject of this cure, the bleeding was used in the most depressed, and apparently weak state of the pulse. It rose constantly with the loss of blood.

The cases related by Dr. Tilton and Dr. Innes were said to be of a spontaneous nature, but themorbid actions were exactly the same in both patients with those which are derived from the bite of a rabid animal. There is but one remote cause of disease, and that is stimulus, and it is of no consequence in the disease now under consideration, whether the dread of water be the effect of the saliva of a rabid animal acting upon the fauces, or of a morbid excitement determined to those parts by any other stimulus. The inflammation of the stomach depends upon the same kind of morbid action, whether it be produced by the miasmata of the yellow fever, or the usual remote and exciting causes of the gout. An apoplexy is the same disease when it arises from a contusion by external violence, that it is when it arises spontaneously from the congestion of blood or water in the brain. A dropsy from obstructions in the liver induced by strong drink, does not differ in its proximate cause from the dropsy brought on by the obstructions in the same viscus which are left by a neglected, or half cured bilious fever. These remarks are of extensive application, and, if duly attended to, would deliver us from a mass of error which has been accumulating for ages in medicine: I mean the nomenclature of diseases from their remote causes. It is the most offensive and injurious part of the rubbish of our science.

I grant that bleeding has been used in some instances in hydrophobia without effect, but in all such cases it was probably used out of time, or in too sparing a manner. The credit of this remedy has suffered in many other diseases from the same causes. I beg it may not be tried in this disease, by any physician who has not renounced our modern systems of nosology, and adopted, in their utmost extent, the principles and practice of Botallus and Sydenham in the treatment of malignant fevers.

Before I quit the subject of blood-letting in hydrophobia, I have to add, that it has been used with success in two instances in dogs that had exhibited all the usual symptoms of what has been called madness. In one case, blood was drawn by cutting off the tail, in the other, by cutting off the ears of the diseased animal. I mention these facts with pleasure, not only because they serve to support the theory and practice which I have endeavoured to establish in this disease, but because they will render it unnecessary to destroy the life of a useful and affectionate animal in order to prevent his spreading it. By curing it in a dog by means of bleeding, we moreover beget confidence in the same remedy in persons who have been bitten byhim, and thus lessen the force of the disease, by preventing the operation of fear upon the system.

2. Purges and glysters have been found useful in the hydrophobia. They discharge bile which is frequently vitiated, and reduce morbid action in the stomach and blood-vessels. Dr. Coste ascribes the cure of a young woman in a convent wholly to glysters given five or six times every day.

3. Sweating after bleeding completed the cure of the boy whose case is mentioned by Mr. Wrightson. Dr. Baumgarten speaks highly of this mode of depleting, and says further, that it has never been cured “but by evacuations of some kind.”

4. All the advantages which attend a salivation in common malignant fevers, are to be expected from it in the hydrophobia. It aided blood-letting in two persons who were cured by Mr. Falconer and Dr. Le Compt.

There are several cases upon record in which musk and opium have afforded evident relief in this disease.

A physician in Virginia cured it by large doses of bark and wine. I have no doubt of the efficacyof these remedies when the disease is attended with a moderate or feeble morbid action in the system, for I take it for granted, it resembles malignant fevers from other causes in appearing in different grades of force. In its more violent and common form, stimulants of all kinds must do harm, unless they are of such a nature, and exhibited in such quantities, as to exceed in their force the stimulus of the disease; but this is not to be expected, more especially as the stomach is for the most part so irritable as sometimes to reject the mildest aliments as well as the most gentle medicines.

After the morbid actions in the system have been weakened, tonic remedies would probably be useful in accelerating the cure.

Blisters and stimulating cataplasms, applied to the feet, might probably be used with the same advantage in the declining state of the disease, that they have been used in the same stage of other malignant fevers.

The cold bath, also long immersion in cold water, have been frequently used in this disease. The former aided the lancet, in the cure of the man whose case is related by Dr. Hartley. There can be no objection to the cold water in either of theabove forms, provided no dread is excited by it in the mind of the patient.

The reader will perceive here that I have deserted an opinion which I formerly held upon the cause and cure of the tetanus. I supposed the hydrophobia to depend upon debility. This debility I have since been led to consider as partial, depending upon abstraction of excitement from some, and a morbid accumulation of it in other parts of the body. The preternatural excitement predominates so far, in most cases of hydrophobia, over debility, that depleting remedies promise more speedily and safely to equalize, and render it natural, than medicines of an opposite character.

In the treatment of those cases of hydrophobia which are not derived from the bite of a rabid animal, regard should always be had to its remote and exciting causes, so as to accommodate the remedies to them.

The imperfection of the present nomenclature of medicine has become the subject of general complaint. The mortality of the disease from the bite of a rabid animal, has been increased by its name. The terms hydrophobia and canine madness, convey ideas of the symptoms of the disease only,and of such of them too as are by no means universal. If the theory I have delivered, and the practice I have recommended, be just, it ought to be called the hydrophobic state of fever. This name associates it at once with all the other states of fever, and leads us to treat it with the remedies which are proper in its kindred diseases, and to vary them constantly with the varying state of the system.

In reviewing what has been said of this disease, I dare not say that I have not been misled by the principles of fever which I have adopted; but if I have, I hope the reader will not be discouraged by my errors from using his reason in medicine. By contemplating those errors, he may perhaps avoid the shoals upon which I have been wrecked. In all his researches, let him ever remember that there is the same difference between the knowledge of a physician who prescribes for diseases as limited by genera and species, and of one who prescribes under the direction of just principles, that there is between the knowledge we obtain of the nature and extent of the sky, by viewing a few feet of it from the bottom of a well, and viewing from the top of a mountain the whole canopy of heaven.

Since the first edition of the foregoing observations, I have seen a communication to the editors of the Medical Repository[86], by Dr. Physick, which has thrown new light upon this obscure disease, and which, I hope, will aid the remedies that have been proposed, in rendering them more effectual for its cure. The doctor supposes death from hydrophobia to be the effect of a sudden and spasmodic constriction of the glottis, inducing suffocation, and that it might be prevented by creating an artificial passage for air into the lungs, whereby life might be continued long enough to admit of the disease being cured by other remedies. The following account of a dissection is intended to show the probability of the doctor's proposal being attended with success.

On the 13th of September, 1802, I was called, with Dr. Physick, to visit, in consultation with Dr. Griffitts, the son of William Todd, Esq. aged five years, who was ill with the disease called hydrophobia, brought on by the bite of a mad dog, on the 6th of the preceding month. The wound was small, and on his cheek, near his mouth, two circumstances which are said at all times to increasethe danger of wounds from rabid animals. From the time he was bitten, he used the cold bath daily, and took the infusion, powder, and seeds of the anagallis, in succession, until the 9th of September, when he was seized with a fever which at first resembled the remittent of the season. Bleeding, purging, blisters, and the warm bath were prescribed for him, but without success. The last named remedy appeared to afford him some relief, which he manifested by paddling and playing in the water. At the time I saw him he was much agitated, had frequent twitchings, laughed often; but, with this uncommon excitement in his muscles and nerves, his mind was unusually correct in all its operations.

He discovered no dread of water, except in one instance, when he turned from it with horror. He swallowed occasionally about a spoon full of it at a time, holding the cup in his own hand, as if to prevent too great a quantity being poured at once into his throat. The quick manner of his swallowing, and the intervals between each time of doing so, were such as we sometimes observe in persons in the act of dying of acute diseases. Immediately after swallowing water, he looked pale, and panted for breath. He spoke rapidly, and with much difficulty. This was more remarkably the case when he attempted to pronounce the wordscarriage,water, andriver. After speaking he panted for breath in the same manner that he did after drinking. He coughed and breathed as patients do in the moderate grade of the cynanche trachealis. The dog that had bitten him, Mr. Todd informed me, made a similar noise in attempting to bark, a day or two before he was killed. We proposed making an opening into his windpipe. To this his parents readily consented; but while we were preparing for the operation, such a change for the worse took place, that we concluded not to perform it. A cold sweat, with a feeble and quick pulse, came on; and he died suddenly, at 12 o'clock at night, about six hours after I first saw him. He retained his reason, and a playful humour, till the last minute of his life. An instance of the latter appeared in his throwing his handkerchief at his father just before he expired. The parents consented to our united request to examine his body. Dr. Griffitts being obliged to go into the country, and Dr. Physick being indisposed, I undertook this business the next morning; and, in the presence of Dr. John Dorsey (to whom I gave the dissecting knife), and my pupil Mr. Murduck, I discovered the following appearances. All the muscles of the neck had a livid colour, such as we sometimes observe, after death, in persons who have died of the sore throat. The muscles employed in deglutitionand speech were suffused with blood. The epiglottis was inflamed, and the glottis so thickened and contracted, as barely to admit a probe of the common size. The trachea below it was likewise inflamed and thickened, and contained a quantity of mucus in it, such as we observe, now and then, after death from cynanche trachealis. The œsophagus exhibited no marks of disease; but the stomach had several inflamed spots upon it, and contained a matter of a brown appearance, and which emitted an offensive odour.

From the history of this dissection, and of many others, in which much fewer marks appeared of violent disease, in parts whose actions are essential to life, it is highly probable death is not induced in the ordinary manner in which malignant fevers produce it, but by a sudden or gradual suffocation. It is the temporary closure of this aperture which produces the dread of swallowing liquids: hence the reason why they are swallowed suddenly, and with intervals, in the manner that has been described; for, should the glottis be closed during the time of two swallows, in the highly diseased state of the system which takes place in this disease, suffocation would be the immediate and certain consequence. The same difficulty and danger attend the swallowing saliva, and hence the symptomof spitting, which has been so often taken notice of in hydrophobia. Solids are swallowed more easily than fluids, only because they descend by intervals, and because a less closure of the glottis is sufficient to favour their passage into the stomach. This remark is confirmed by the frequent occurrence of death in the very act of swallowing, and that too with the common symptoms of suffocation. To account for death from this cause, and in the manner that has been described, it will be necessary to recollect, that fresh air is more necessary to the action of the lungs in a fever than in health, and much more so in a fever of a malignant character, such as the hydrophobia appears to be, than in fevers of a milder nature. An aversion from swallowing liquids is not peculiar to this disease. It occurs occasionally in the yellow fever. It occurs likewise in the disease which has prevailed among the cats, both in Europe and America, and probably, in both instances, from a dread of suffocation in consequence of the closure of the glottis, and sudden abstraction of fresh air.

The seat of the disease, and the cause of death, being, I hope, thus ascertained, the means of preventing death come next under our consideration. Tonic remedies, in all their forms, have been administered to no purpose. The theory of the diseasewould lead us to expect a remedy for it in blood-letting. But this, though now and then used with success, is not its cure, owing, as we now see, to the mortal seat of the disease being so far removed from the circulation, as not to be affected by the loss of blood in the most liberal quantity. As well might we expect the inflammation and pain of a paronychia, or what is called a felon on the finger, to be removed by the same remedy. Purging and sweating, though occasionally successful, have failed in many instances; and even a salivation, when excited (which is rarely the case), has not cured it. An artificial aperture into the windpipe alone bids fair to arrest its tendency to death, by removing the symptom which generally induces it, and thereby giving time for other remedies, which have hitherto been unsuccessful, to produce their usual salutary effects in similar diseases[87]. In removing faintness, in drawing off the water in ischuria, in composing convulsions, and in stopping hæmorrhages in malignant fever, we do not cure the disease, but we prevent death, and thereby gain time for the use of the remedies which are proper to cure it. Laryngotomy, accordingto Fourcroy's advice, in diseases of the throat which obstruct respiration, should be preferred to tracheotomy, and the incision should be made in the triangular space between the thyroid and cricoid cartilages. Should this operation be adopted, in order to save life, it will not offer near so much violence to humanity as many other operations. We cut through a large mass of flesh into the bladder in extracting a stone. We cut into the cavity of the thorax in the operation for the empyema. We perforate the bones of the head in trepanning; and we cut through the uterus, in performing the Cæsarian operation, in order to save life. The operation of laryngotomy is much less painful and dangerous than any of them; and besides permitting the patient to breathe and to swallow, it is calculated to serve the inferior purpose of lessening the disease of the glottis by means of local depletion. After an aperture has been thus made through the larynx, the remedies should be such as are indicated by the state of the system, particularly by the state of the pulse. In hot climates it is, I believe, generally a disease of feeble re-action, and requires tonic remedies; but in the middle and northern states of America it is more commonly attended with so much activity and excitement of the blood-vessels, as to require copious blood-letting and other depleting remedies.

Should this new mode of attacking this furious disease be adopted, and become generally successful, the discovery will place the ingenious gentleman who suggested it in the first rank of the medical benefactors of mankind.

I have only to add a fact upon this subject which may tend to increase confidence in a mode of preventing the disease which has been recommended by Dr. Haygarth, and used with success in several instances. The same dog which bit Mr. Todd's son, bit, at the same time, a cow, a pig, a dog, and a black servant of Mr. Todd's. The cow and pig died; the dog became mad, and was killed by his master. The black man, who was bitten on one of his fingers, exposed the wound for some time, immediately after he received it, to a stream of pump water, and washed it likewise with soap and water. He happily escaped the disease, and is now in good health. That his wound was poisoned is highly probable, from its having been made eight hours after the last of the above animals was bitten, in which time there can be but little doubt of such a fresh secretion of saliva having taken place as would have produced the hydrophobia, had it not been prevented by the above simple remedy. I am not, however, so much encouraged by its happy issue in this case as to adviseit in preference to cutting out the wounded part. It should only be resorted to where the fears of a patient, or his distance from a surgeon render it impossible to use the knife.

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