Treatment

Happily surgery possesses one tolerably certain means of preventing hydrophobia, when it is practised in time and in a complete manner.

Every reader will immediately conclude that the excision of the bitten parts is the operation to which I allude. Now it is absolutely necessary that the operation should be done completely; for a timorous surgeon, afraid of cutting deep enough or of removing a sufficient quantity of the surrounding flesh, would be a most dangerous one for the patient. For it must be borne in mind that all hope of life depends on the prevention of the dreadful disease; for, in the present state of medical knowledge, none can rest with the slightest security upon the efficacy of any plan except the extirpation of the part. For this purpose caustics have often been employed. However, as their action can never be regulated with the same precision as that of the knife, and consequently they may not destroy the flesh to a sufficient depth, excision should always be preferred. The latter method is also the safest for another important reason, namely, the part, and poison lodged in it, are removed from the body at once and for ever; but when the cautery or caustic is used, the slough must remain a certain time undetached.

Some men are not content with cutting out the part, but after the operation fill the wound with the liquor ammoniae, or cauterise its surface for the Bake of greater security. This is an additional precaution greatly to be commended. How late excision may be done with any prospect of utility I am not prepared to say, but there are medical men who deem excision right even when heat, irritation, or inflammation is observed in the bitten part.

Case* may present themselves in which it is even preferable to amputate the limb than attempt to extirpate either with the knife or cauterise the whole of the bitten parts, - an endeavour which could not be accomplished with any degree of certainty. For example, if the hand or foot was deeply bitten in several places by a mad dog or other rabid animal, it is obvious that it would be impossible to make caustic or the actual cautery reach every part which the saliva of the animal may have touched. Besides, the mischief resulting both from the injury and the other proceedings together might be such as to afford no prospect of saving the limb, or at least of preserving it in a useful state.

Two cases occurred in which the patients lost their lives in consequence of the excision or destruction of the bitten parts not having been attempted, on account of the surgeon's reluctance to cut tendons or wound a large artery.

In such cases the fear of rendering a muscle useless or of wounding an artery is no justification for leaving the patient exposed to danger so surely fatal as that of the hydrophobic vims if it once affects the constitution. Now, when once the hydrophobic symptoms have commenced, there is no hope of saving the patient, the disease having up to the present time invariably baffled every plan of treatment which the united talents of numerous medical generations have suggested.

All the most powerful medicines of every class have been tried again and again and again - mercury, opium, musk, camphor, belladonna, ammonia, bleeding, plunging the patient in the sea, etc. - but all have signally failed, and proved ineffectual to cope with this gigantic enemy.

The insufficiency of opium is now generally acknowledged. In the space of fourteen hours Dr. Vaughan gave one patient fifty-seven grains of opium and also half an ounce of laudanum in a glyster, but the fatal termination of the disease was not prevented. Dr. Babington even prescribed the enormous quantity of one hundred and eighty grains in eleven hours, without the least amendment, or even any narcotic effect.

Again, on the very first day that rabies decidedly showed itself, a man who had been bit by a mad dog had injected into his veins, by means of a syringe, two grains of the extract of opium dissolved in distilled water; and as a degree of calm appeared to be the result, four grains more were thrown into the vein. The patient remained perfectly tranquil three hours longer, but the symptoms afterwards recurred with increased violence. The next morning eight grains more were dissolved and thrown into the circulation, but all was in vain, as the patient died in three-quarters of an hour after the last injection. A solution of the acetate of morphia has been tried also, but without success.