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 the morbid 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 by him, 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 efficacy of 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.