Haly Abbas allows bleeding when the poison is distributed over the body, and like the others also, makes mention of cupping with heat and of amputation. He also joins in the general praise of the theriac.
Alsaharavius recommends strong ligatures, cupping, and, in urgent cases, amputation. He also approves of applying the bodies of hens still warm. Serapion approves of bleeding under the same circumstances as the others, and of the same general treatment that they recommend. Rhases recommends sucking and cupping the wound, and the application of stimulant dressings, such as a plaster consisting of mustard, lime, and pitch. He, and most of the ancient authorities on toxicology, recommend salt as an application to the wound. Most of them also join Dioscorides in recommending the application of caustic leys. They also in general direct us to prevent sleep. The ligature to prevent absorption is recommended by Rhases, as it is in fact by most of the ancient authorities. As a matter of course all of them speak highly of the theriac, and acquiesce in Galen’s celebrated eulogy upon its virtues. (Ad Pison. ii, 457, ed. Basil.)
The Arabian authorities notice cursorily the treatment of poisoned weapons of war, more especially of the Armenian arrows. Galbanum and assafœtida administered internally, and applied to the wounds in various forms, are the two articles which are most generally approved of by them. They also recommend sucking the wound, as in other cases of poisoning by a wound. (See further, [B. vi, 88].)
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.)