Medical Inquiries and Observations, Vol. 2 / The Second Edition, Revised and Enlarged by the Author

by Benjamin Rush

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 the above 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 increase the 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.