HYDROPHOBIA.
To the Editor of the London Medical Gazette.
Sir,
As the following case may throw some additional light on the pathology of hydrophobia, I have sent it you for publication.
I am, Sir,
Your obedient servant,
F. Godrich.
Grove House, Little Chelsea,
Nov. 29, 1828.
On Thursday morning, the 25th ult. I was called up about seven o'clock to see a man who I understood was exceedingly ill, and waiting in the surgery very impatiently for my arrival. I found my patient (Mr. Barham), a fine looking old man, about 60, labouring at intervals of about five minutes under strong spasmodic paroxysms, affecting the muscles concerned in breathing and deglutition. There was a wildness and an impatience depicted in his countenance, totally different from any thing I had ever observed in other spasmodic affections. His bowels were open, tongue clean, skin moist, pulse full and a little accelerated. I took away twenty ounces of blood, and prescribed a mixture containing ʒss.
ss. of laudanum for a dose every hour until I should see him again. He walked home half a mile from my house (Gloucester Road, Old Brompton), and left me ruminating on the possible cause of so much mischief occurring suddenly in a fine healthy subject. At ten a message was sent, saying that he was much worse, and requesting me to call as soon as possible. He received me tranquilly, and said he was very glad that I had come to see him, for he was very ill. His symptoms were now more distressing than when I first saw him: he looked wildly and suspiciously at every one entering his apartment, and his breathing was accompanied by a short convulsive sobbing. On looking at his medicine I perceived he had taken none, and expressing my surprise, he assured me it was impossible for him to swallow a single drop, as the attempt had been followed by violent spasms, and produced so much distress, that he had desisted. At this period no one had the slightest idea of the origin of his malady. I poured out some medicine into a tea-cup, the very act of which produced much excitement and alarm. My first impression as to the true nature of his disease arose at this period, from the circumstance of his requiring a tea-spoon, with which he endeavoured to take some of the medicine. The attempt produced much excitement and alarm, and after two or three painful efforts at deglutition, with one desperate effort he swallowed a tea-spoonful, threw away the spoon, and begged, unless I wished to destroy him, that he might have nothing more to swallow. I now left his room, and inquired of a bystander whether any thing particular had occurred to him within the last few weeks. On recollection she said, "About a month since, late at night, a strange dog came into the premises and fought with his own dog; he got out of bed to separate them, and the strange dog bit him in two places, on the left arm and hand; and bit a puppy, which died about a fortnight after in a strange way, which was thought to be some kind of a fit." To ascertain if this occurrence had produced any effect on his mind, while again bleeding him I said, "You have been in the wars, Sir, and had your hand and arm torn; how did it occur?"—"Oh!" said he, carelessly, "that was done by a dog a long time ago, but it healed." The circumstance was never again mentioned to him, and he died in total ignorance of the cause of his malady. The wounds were perfectly cicatrised, and there was not the least action going on indicative of recent absorption. He bore the bleeding pretty quietly: 40℥.40
. were removed, which on cooling presented strong marks of inflammation.
Ordered ℳiv.
iv. Acid. Hydrocyan. omni horâ, in a little water.
Twelve o'clock.—With much difficulty he has taken two doses of the acid; pulse full and hard, 110. 30℥.30
. more blood were removed.
Three o'clock.—Has taken two more doses; complains of a dreadful sense of suffocation, and implores that nothing more may be given him. Pulse full, and beating at 120 to 130. Continue the acid.
Eight o'clock.—Pulse full and hard. Has taken in all 24ℳ.24
. of the acid, but so painfully distressing has the deglutition now become, that all attempts at repeating his medicine are discontinued.
V. S. ad ℥xxx.
xxx.
During the bleeding he looked wildly at the basin, and begged that no more might be spilt (a drop or two had fallen), repeating frequently, in great agitation, as the blood was running, "Take care! take care!"
Between two and three o'clock next morning my assistant (Mr. Davies) visited him. He found him tolerably passive, but observing every movement with intense anxiety. Pulse full and hard, face flushed, eyes denoting cerebral irritation. He had been at times outrageous. On its being intimated that bleeding was again necessary, a paroxysm came on more intense than any preceding,—and with great effort he submitted. As the blood flowed he became more and more alarmed, till at length he got quite unmanageable; he raged violently at his nephew, who was holding the basin, and ordered it peremptorily to be removed. 30 or 40℥.40
. were taken away. It was found necessary to put on the straight waistcoat. About four o'clock Mr. Davies wished him to take some more of his medicine. He said, "I can take no more," and on reaching the bottle to put out a few drops, he became violently agitated, threw himself from side to side, and, as well as the incessant spasmodic sobbings would allow, he begged that not one more drop of any thing might be offered him, and that the bottle might be taken from his sight. He did not become tranquillized until its removal. He lingered on till ten A.M. in the same state, a few minutes before which he insisted on getting up, and walked a short way down his garden, returned, laid down on his bed, and died.
Mr. Frederick Salmon, of Old Broad Street, and Mr. Wilson, of Chelsea, were kind enough to assist me in conducting the post mortem examination. On opening the chest, the heart was free from disease, with rather more water in the pericardium than natural; the lungs were completely gorged with grumous blood, and the pleura adherent on the right side. On removing the cranium, which was remarkably thin, and cutting the substance of the brain, numerous red spots presented themselves in the medullary portion; about a table-spoonful of water in each ventricle; the plexus choroides was turgid; the corpora, striata, thalami, and basis of the brain every where preternaturally injected; the cerebellum, crura cerebri, and cerebelli, in a high state of inflammation. On removing the spinous process of the vertebra, the whole cord was considerably inflamed; and opposite the two last cervical and dorsal vertebræ the cellular substance was studded with dark patches of coagulated blood, the theca vertebralis thickened, and the cord in an active state of inflammation. The larynx and pharynx bore not the slightest vestige of disease. The preparation of the cord is deposited in the museum of the London University.
The post mortem examination of this case tends to prove the correctness of Professor Thompson's theory of the proximate cause and seat of this afflicting malady; and the plate accompanying a case recorded by him, in the 13th volume of the Med. Chir. Society, gives a faithful delineation of the state in which the spinal cord was found in this case.