The seven books of Paulus Ægineta, volume 2 (of 3)

by Aegineta Paulus

SECT. III.—ON PERSONS BITTEN BY MAD DOGS, AND ON HYDROPHOBIA.

We have placed the account of persons bitten by mad dogs before all the others because these animals are numerous and domestic, and are frequently seized with madness; because the complaint is difficult to guard against, and the danger inevitable, unless one have recourse to many and suitable remedies. Dogs for the most part become mad during violent heat, but also, as Lycus says, sometimes in extreme cold. When mad they shun drink and food, for they are thirsty but do not drink, and for the most part they pant, hang their ears, and emit much frothy saliva. Generally they utter no sounds, and are as it were delirious, so that they do not recognize persons with whom they are familiar. Wherefore they attack equally without barking all animals, whether wild beasts or men, and bite them. Their bite at first occasions nothing disagreeable except the pain of the wound; but afterwards it brings on the affection called hydrophobia, which makes its attack with convulsions, redness of the whole body, but especially of the countenance, sweating, and anxiety; and those affected shun water when they see it, and some every fluid that is presented to them. Some bark like dogs and bite those who approach them, and so doing they occasion the same affection. The cause of the other symptoms is obvious, being occasioned by the poison affecting all the parts, but as to the dread of water some have said that it is occasioned by inordinate dryness, as if the whole fluids of the body had undergone a change. But Ruffus has pronounced it to be a species of melancholy which affects them, the poison putting on the nature of that humour in like manner as we know other melancholic persons dreading some one thing and some another; which reason accords also with those who say that they think they see the image of the dog that bit them in the water. Of persons falling into this affection we know none who has been saved, except that we have learned the histories of one or two cases, and these were of persons who had been bitten, not by a mad dog, but by some person who had been bitten and imparted the disease to them. But before the affection has made its attack many, even of those who have been bitten by a dog, have been saved. Wherefore we must begin the treatment from thence. And since often from the attack of hydrophobia having not yet come on (for most commonly it comes on about the fortieth day, and in some cases after six months, nay, instances are related of its coming on after seven years,) some supposing that the dog who inflicted the bite was not mad, and making haste to heal up the wound have thereby given rise to the complaint. By the following experiment you may ascertain whether the bite was inflicted by a mad dog or not: Pound walnuts carefully and apply them to the wound, and next day take and present them for food to a cock or hen. At first indeed he will not touch them, but if he is compelled by hunger to eat of them, observe, for if the dog that inflicted the bite was not mad, then the fowl will live, but if mad he will die next day; and then you must hasten to open the wound, and after a few days repeat the same experiment; and when the fowl does not die you may bring the wound to cicatrization, inasmuch as the patient is then freed from danger. Oribasius recommends this experiment: If from the symptoms which we have mentioned we know for certain that the dog is mad, we must have recourse to medicines for laying open the sore, the principal of which is that from pitch, very acrid vinegar, and opoponax, which is described accurately in the section on the wounds of nervous parts. But if the person who has been bitten has a tender skin, it is to be diluted with oil of iris, of balsam, or the like; or having first fomented the sores, apply a cataplasm of garlic. This also forms eschars. A dry escharotic for persons bitten by mad dogs: Of fossile salts, dr. viij; of chalcitis, dr. xvj; of squills, dr. xvj; of green rue, dr. iv; of scraped verdigris, dr. iv; of the seed of horehound, dr. j; use it at first dry that it may form an eschar, and then with rose-oil that the eschars may fall off. Keep the parts from cicatrizing for forty-two days at least. A cataplasm for persons bitten by mad dogs, which keeps the mouth of the wound open: Apply a cataplasm of onions with salts and rue, or of laserwort with salts, or of old pickle, or of the cinders of burnt wood with oil, or of garlic, or apply the leaves of the elder tree, or mint, or baum, each with salts, or walnuts with onions, salts and honey, or the ashes of figs mixed with cerate. Wash the sore with a decoction of camomile in water, and the root of the wild dock. But some burn the sore with heated irons. They ought in the first place to get draughts of simple things, such as buckthorn, wormwood, the juice of laserwort, germander, the water germander, and poley. These are compound applications: Of river crabs, of the shoots of the white vine burnt in a vessel of copper or bronze two spoonfuls, of gentian root triturated one spoonful, give to drink for forty days, with two cyathi of old undiluted wine. Some add two spoonfuls of the blood of the partridge. The crabs are to be taken when the moon is on the increase before sun-rising. But to those who do not drink it every day give a double doze, and sometimes a triple. And the theriac from vipers may be given with advantage. The patient is to be purged with the preparation from the wild cucumber, which is to be given every day with the decoction of sage, or with the Heraclean ironwort, which is also called alysson. Some also give the liver of the dog that inflicted the bite to eat. Such a diet is to be given as blunts and extinguishes the power of the poison, and at the same time prevents it from being carried deeper into the system. Both these ends may be accomplished by drinking old sweet wine that is both undiluted and strong, or milk, and in like manner by eating garlic, onions, and leeks. But if from some hinderance at the commencement the remedies which we have described have been neglected, scarification, cupping, or burning the wound, must not be had recourse to, because the poison has already been carried to the deep-seated parts; but we must use the remedies called metasyncritica, that is to say, when the attack of hydrophobia has not come on. Purging with hiera and divided milk is also to be had recourse to, with sudorifics; and calefacient plasters, and sinapisms are to be applied to every part of the body. But the most effectual of all remedies is a course of hellebore frequently repeated.

Commentary. Aristotle is the first author who mentions hydrophobia, but his account of it is remarkably incorrect, if the text be not corrupted. He says, all animals that are bitten by a rabid dog are affected with the disease except man; and that the disease proves fatal to all animals but man. (H. A. viii, 22.) But see the Annotations of Schneider. (l. c.) Ovid ranks inveterate gout and hydrophobia among the incurable diseases:

“Tollere nodosam nescit medicina podagram,

Nec formidatis auxiliatur aquis.”

Ex Ponto, i, 3, 24.

Celsus, also, was well aware of the fatal nature of the disease, for which he says the only remedy is to plunge the patient unexpectedly into the cold bath, after which, to prevent convulsions, he is to be put into warm oil. He also approves of giving undiluted wine. As a preventive of the disease he directs the wound to be cauterized. (v, 27.)

Pliny in like manner reckons the disease dangerous, and mentions hellebore as a remedy for it. (H. N. viii, 63; xxix, 32.)

But without doubt the best account of hydrophobia contained in any ancient author is that given by Cælius Aurelianus. We shall now give a short abstract of it. He says the disease may be produced not only by the bite, but likewise by the breath of a rabid dog. This fact is mentioned by other authorities, such as Aretæus (Morb. Acut. vii), and Vegetius (Mulo. Med. iii, 84); and it is confirmed by modern writers, as Gokel, Lister, Rhazouz, and others. He also relates the case of a sempstress who fell into the disease from having sewed a robe which had been torn by a mad dog. Similar cases are related by Hildanus and Heister. He likewise states, what is confirmed by the Arabian authorities, and also by modern experience, that the disease may be brought on by the bite of wolves, bears, leopards, horses, and asses. He mentions the case of a person in whom it was occasioned by a wound inflicted with the spurs of a cock while fighting. Sometimes, too, he adds, it arises in the human subject without any manifest cause, which also is confirmed by modern experience. We once saw the horror of water in a case of Phrenitis. He mentions a singular case of hydrophobia in a child which was affected with a horror of its mother’s breast. His description of the symptoms, if compared with modern descriptions (for example that given by Dr. Goden in Hufeland’s ‘Journal,’ Jan. 1816), will be found in every respect complete and accurate. Thus Cælius says that the pulse is densus, parvus, inordinatus, and Goden found it intermittent and irregular. Cælius says there is a frequent desire of making water, which Goden found to be a constant attendant of the disease. Cælius thought that the stomach is more deranged than any other part, and Goden is of opinion that the splanchnic nerves are particularly affected. In short, Cælius maintained that it is an incendium nervorum; and it appears from him that some of the ancient authorities believed it an inflammatory affection, and treated it by bleeding. He treats it upon much the same principles as Tetanus, that is to say, his great object seems to have been to remove constriction, and with this view he recommends friction with tepid oil, venesection, and all remedies of a relaxant nature. He also directs us to administer clysters of tepid water and oil; and proposes to quench the thirst by forcing a cooling injection up to the stomach; for which purpose pressure with the hands is to be applied externally. He makes mention of the internal administration of hellebore, but disapproves of it. The use of white hellebore, however, is favorably mentioned by Aëtius (vi, 24), by Actuarius (Meth. Med. vi, 11), by Theomnestus (Geopon. xix, 3), by Dioscorides (ii, 3), by Alexander Trallian (i, 15), and by Avicenna (iv, 6, 9.)

Galen, in his work on ‘Antidotes,’ gives prescriptions for several compositions of this sort for the prevention and cure of hydrophobia; and mentions the disease incidentally in several parts of his works, but has nowhere given any description of it. Dioscorides’ account of the symptoms, and his plan of treatment are nearly the same as our author’s. He strongly recommends the cautery.

The external application of the cautery is also commended by Celsus, Galen, Pliny, Scribonius Largus, Aëtius, Actuarius, Nonnus, Avicenna, Rhases, and Alsaharavius.

See a good account of hydrophobia in Haly Abbas (Theor. viii, 20); and in Alsaharavius (Pract. xxx, 2, 30.) None of the ancient authorities insists with so much earnestness as Haly Abbas on the necessity of applying strong stimulants to the wound, namely, the most acrid vinegar, copperas, and the like, so as to keep up a discharge from it for a considerable time. Rhases is a strong advocate for bleeding when the poison is distributed over the system. (Cont. xxxv.)

Perhaps Alexander Aphrodisiensis is correct in stating that the disease in the dog is a species of fever. (Problem.)

There is a sensible account of hydrophobia in a ‘Fragment’ of an anonymous Greek author, published in Bernard’s ‘Reliquiæ.’ The complaint is said to arise either from the bite of a dog, or from humours engendered in the body. It is correctly stated that persons affected with it dread all liquids, so that at the bare mention of them they start up with a scream, trembling, cold sweats, and chattering of the teeth. Among other things cold applications over the stomach and chest are recommended.