Preventive Treatment

As soon as possible after the bite of a suspected animal the whole wound should be freely and fairly cut out. After this, bleeding should be encouraged by the application of a cupping glass; or the wound should be long and diligently washed in warm water. But if the bite have been irregular, (so that it is uncertain whether the excision has been complete,) it should be cauterised by Nitric Acid, or, as Sir B. Brodie recommends, by passing a probe which has been dipped into caustic potash, (melted in an iron spoon,) into every nook and corner of the wound.

When we consider that substances introduced fairly into the blood may find their way all over the body in an inconceivably short space of time, (probably in nine seconds,) it will be readily seen that excision, although performed as soon as possible after the bite, may be of no avail. Yet it should never be omitted, let the interval be what it may. And one case is recorded in which it is said, that the patient was saved, although the parts were not cut out till the thirty-first day, and not till the symptoms had actually made their appearance. This, however, is doubtful.

By some authors caustic is recommended to the exclusion of excision; especially the nitrate of silver, by Mr. Youatt. This gentleman has certainly a good right to speak in its favour, having been bitten four times, and having used no other preventive. But other cases are narrated in which the immediate and free application of this substance was totally useless. Whether the wound after excision or caustic should be allowed to heal, or be kept open and made to suppurate by irritating ointments, is a disputed point, The weight of authority certainly favours the latter practice, and beyond the inconvenience it can do no harm.

As for any other preventive treatment, all that can be done is to keep the patient in as good a state of health, and in as good spirits, as possible. But there is not one of the innumerable so-called specifics that is worth a moment's trial. The Tonquin, Orms-kirk, and Burling nostrums;-guaco, box, belladonna, and broom tops; all kinds of acids, alkalies, earths, and vegetables; half drowning the patient in the sea; and stewing him in hot air and vapour baths -all these remedies and plans have in turn been reputed infallible, and found to be good for nothing. At one time it was confidently pretended that certain vesicles appear under the tongue during the premonitory symptoms, and that if these were cauterised, the patient would be safe. But unluckily they can never be found. Mr. Youatt thinks that Rue acts occasionally as a preventive with dogs, but it is very far from infallible.

Curative Treatment

Here we are met at the outset with the doubt whether Hydrophobia can be cured at all; whether, like the plague and small-pox, it will not run its course, without the possibility of checking it. Mr. Youatt says that he believes he has occasionally prevented it in the dog, and that he has occasionally-seen a case of spontaneous recovery; but that he has never cured it. And with regard to man, although it cannot be denied that a few rare cases have recovered;-still, as the same remedies that were supposed to be successful in these cases, have been used again and again in others without benefit, the recoveries must fairly be considered accidental and spontaneous.

Bleeding has been frequently tried to a most enormous extent, and one case in the East Indies is said to have been cured by it; but it rarely affords even a temporary alleviation, and rather tends, by exhausting the strength, to accelerate the fatal issue. It may, however, be tried as a palliative if the patient is plethoric, and the face becomes very turgid during the spasms.

Warm Water

Magendie and others have proposed, after bleeding, to inject large quantities of warm water into the veins; and it certainly is beneficial, although but for a time.

Opium in different forms has been given most profusely, and certainly with some success;-for whether administered by the mouth, or rubbed into the skin, or injected into the veins, it seldom fails to mitigate the patient's sufferings, although it never averts his death. This was most strikingly exemplified in the case of the Milbank prisoner, who died seven years after he was bitten. A blister was applied along the spine, and ten grains of acetate of morphia were sprinkled on the denuded cutis. "Scarcely had one minute elapsed," says Dr. Burne, "when we observed the stare of the eyes and the dreadful alarm and anxiety of the countenance to diminish, then the violence of the spasm to abate, and the catchings in the respiration and the retching to subside; and to our astonishment this general amelioration progressed, till in four minutes the countenance had become placid, and the respiration free; the retching had ceased, and the spasms vanished, This improvement, however, did not last very long:-the symptoms returned, a repetition of the remedy was powerless,-and the patient died. And this is the general history of the effects of opium."

The whole tribe of sedatives, belladonna, digitalis, tobacco, etc., have been repeatedly tried, but with similar results. The hot air bath and cold affusion,-acid and alkalies, especially ammonia;-every diuretic, purgative, and sudorific that can be thought of, has succeeded no better. In one instance the liquor plumbi diacetatis is said to have effected a cure.

In a case which occurred in the King's College Hospital, the-suffocative spasms were entirely relieved by letting the patient eat large quantities of ice, and applying it externally to the spine and throat; and the last thing that has been tried is the resin of Indian hemp; but a brief respite from suffering is the utmost good they can produce.

Mr. Hewitt, surgeon in the Bombay Medical establishment, has related a single case in which the patient was saved by violent salivation. Several native soldiers and other persons were bitten one night by a wild jackall, which when killed was found to be very feeble and apparently starved, and its liver rotten and full of abscesses. A month afterwards two of the persons that had been bitten were found dead in the fields, and, from the description which was given of their symptoms, Mr. Hewett judged that they had died of Hydrophobia. Shortly afterwards, three others were seized with the disease, and came under his treatment. He induced salivation in one of them (a woman) by the most profuse administration of mercury, and she recovered; but with the other two, who were men, the same remedy was of no avail. Strangely enough, the natives of these parts were entirely ignorant that such a disease as Hydrophobia existed;-a sufficient refutation of the perverse error of those who maintain that it is entirely an imaginary affection brought on by fright.