m
A«
INAUGURAL DISSERTATION
ON  RABIES CANINA;
SUBMITTED TO THE CONSIDERATION
THE HONOURABLE ROBERT SMITH, PROVOST,
AND OF THE
REGENTS OF THE UNIVERSITY OF MARYLAND,
     Br WILLIAM W. WALLS,

Of Wiacheiter, Virginia, Member of the Baltinwre Medical Soeiety.
tieu Mihi! tot Mortes homini quit Membra Malisque,
Tot nanus infecti, Mors ut Medicina putetur...,.Linns.u%.
         BALTIMORE:

PRINTED BY RALPH W. POMEROY,
      NO. 12, LIGHT STREET.
             181*. 
 
I
               INTRODUCTION.


    IN the following observations on canine madness, the
author is conscious, that although the peculiar malignity
of the disease, and the interest with which it is from this
circumstance Invested, are motives which invite to its ex-
amination, yet  the doubt and obscurity in  which it is in-
volved,  and from which the efforts of genius  and experi-
ence have as yet been inadequate to rescue it, ought per-
haps to  be sufficient to deter him from any disquisition.
    To  a graduate  in medicine, it  is perhaps sufficient
praise  to have escaped censure.  And if, in the  brief
course of his remarks, he has  been fortunate enough to
offer one fact, or suggest one observation on which supe-
rior talent or better experience may build, he will account
-himself sufficiently rewarded. 
 
EABIES CANINA.
   MEDICINE, in common with other sciences, has suf-
fered much from the ambiguity and indefinite application
of terms: of  this, the  subject of  this  essay, furnishes
abundant evidence.  This disease,  from one of its most
prominent symtoms, a dread of water, has been called %
hydrophobia l  and rabies canina, from its being produced
by the canine virus.  I adopt the latter term, though not
unexceptionable, because I consider it more so than the
former j the latter designating the uniform, and indeed
only remote cause of the disease, while the former mis-
leads by exhibiting that  for  the disease,  which is but a
prominent symptom.

HISTORY OF THE DISEASE, AND THE REMOTE
                 CAUSES IN DOGS.

    UNTIL the time of Celius Aurelianus, who flourished
in the reign of Hadrian and Trajan, medical history ex-
hibits no trace of the existence of this disease : that it
prevailed, however, before the time of that author, seems
evident from his having devoted a  whole chapter to the
discussion of the question, whether  the disease was of an-
cient  or  modern  origin. But all  writers  have agreed
that Homer has fixed the sera of its rise, anterior to his
day, by that passage in the 9th Iliad, where he compares
the vehement rage of Hector, to the fury of canine mad-
                         B 
                         10

uess.   The result of the most sedulous researches, into
the remote ages  of antiquity,  in  order to develope  the
precise period in which certain  diseases originated, while
it is uncertain  and unsatisfactory,  affords us  few prin-
ciples of much  practical  utility.  The earlier records of
medicine were little more than a display of the ignorance
and superstition of those  times.
    Almost all animals are liable to the canine disease in
a derivative way; but its spontaneous production is confi-
ned to the  eaain*  race.   It is true, that  Boerhaave  has
given credit to  the idea that domesticated fowls are sub-
ject to it, without receiving the infection from any other
animal.  And Morgagni and some others, have supposed
that the cat genus was  also liable to be spontaneously
affected.  But  the result of  subsequent, and probably
more  accurate observation, has been  such as to discredit
the opinion, and confirm the  position, that no race of
animals, except the canine, are spontaneously affected with
this disease.   When canine madness prevailed, as  an cpi-
demick in the West Indies, its ravages appeared to be con-
fined  to the dogs, except  that oth >r animals received it in
the ordinary way of  communication.   Certain diseases
seem  to be peculiar to certain animals : thus the venereal
disease cannot he  communicated to inferior animals, as
appears from the experiments of Doctor Hunter.
    A variety of remote causes have been assigned by
different <w ritcrs, for the production of canine madness in
 those animals to which it is peculiar,  of some of which it
 may  he proper to take a cursory view.
    1st,  Putrid aliment.
    2nd, A deficiency of water.
    3th, Atmospherick influence. 
11
   These are the principal agents to which has been at-
tributed the production of this disease.   Some of which
are of doubtful application.
    1st,  If putrid aliment were  an efficient  cause, we
should have  the  disease occuring more frequently, and
constantly than is agreeable to observation,  and indeed
dogs have been known to feed  upon putrid aliment, and
even to devour the bodies of other animals that had died
of canine madness, without being disordered.
    2d, A deficiency of water.   Notwithstanding the an-
tiquity of this opinion, it cannot be received without some
hesitation from the fact, that the disease is rarely seen
in those islands in which there is always a deficiency of
water, as in the island of Antigua.
    3d,  Atmospherick influence, may pevhapsbe conside-
red as the most active agent in the production of this dis-
ease : excessive heat  and cold are those qualities of the
air which have been supposed to engender it ; but a more
probable opinion  is, that the  alternation of these two
states* is more hurtful than the continued action of either.
That some peculiarity in the constitution of the atmos-
phere, is the efficient cause, will appear from the disease
occurring as an epidemiok.  In 1783,  it prevailed in Ja-
maica and Hispaniola, in neither of which islands had it
occurred for forty or fifty years, or perhaps ever, before.*
The disease is said also by Ulloa to be  unknown on the
vast continent  of  South America,!  and Volney  says it
never occured in Egypt.  The main design of this essay,
however, was not  to delineate the disease as it occurs in
dogs, but to investigate its character as it displays itself
in the human species.
 * Mosely on Tropical Diseases, p. 0.
 f Do. 
12
  THE REMOTE CAUSES IN THE HUMAN KIND.

     A VARIETY of remote  causes have been enumera-
 ted by the ancients, and received with confidence and re-
 spect by the  moderns.  The opinion that  this disease
 arose spontaneously, or independently  of the agency of
 the canine virus, was maintained by Aurelius and Celsus,
 and  supported by Boerhaave  and his commentator Van
 Swieten.   Notwithstanding, however, this high authori-
 ty, and the zeal with which the opinion has been suppor-
 ted, its fallacy and  inaccuracy appear to me to be suffi-
 ciently obvious.  The bare enumeration of those various
 causes, must at once impress us with the idea, that the
 hydrophobick  symptom has been the prolifick source of
 errour;  for every disease in which the patient was inca-
 pable of  swallowing liquids,  was  believed  to be canine
 madness, and  of consequence the cause that produced the
 disease, of  which hydrophobia was an accidental symp-
 tom, added to the  catalogue of remote causes.   Thus
•Boerhaave relates a case of ardent  fever, produced by
 exposure  to a hot sun,  and drinking  nothing but  ardent
 spirits, as a cause of spontaneous hydrophobia.*  Inflam-
 mation of the stomach,! wounds in the  tendinous parts,!
 hysteria,|| and vicissitudes of  the weather, have all been
 enumerated as remote causes  of this disease.  Dr. Ar-
 thaud relates  three cases produced by the latter causes in
 the West Indies: but from the resemblance which tetanus
 bears to this disease, particularly in regard to the hydro-
 phobick symptom, and from tetanus being so frequently in-
 * Van Swieten's Commentaries.
 f- Medical  Essays, vol. 6.
 X Zoonomia.
 ll Medical Commentaries, vol. 6,p.l29. 
13
duced  in those hot  climates  by this cause, it is highly
probable the doctor  was  mistaken, and that  these were
cases of tetanus.   The impropriety of detailing these as
remote causes, and the cases  enumerated as cases of the
disease in question, is too glaring to merit much attention:
with as  much propriety might the plague be called lues
venerea, and the small  pox identified  with  intermittent
fever, because there exist certain  signs similar,  in both
I therefore reject all the remote causes which have been
enumerated, and consider the canine virus,  as the only
efficient cai:se in  the production  of  this  disease, and
which designates it from all others by an assemblage of
symptoms peculiar to itself, as well as by its pre-eminent
power and mortality.
     The medium through which the virus acts in produ-
cing a disease so horrible in its aspect, and destructive in
its nature, has not  escaped the enquiry of physicians.—
The ancients supposing it to be the most  subtile, pene-
trating poison, imagining the sphere of its deleterious in-
fluence to be very extensive, and that the system was lia-
ble to be assailed successfully, from almost every point.
The various avenues through which the disease is said to
have been imparted, are :
     1st, Through the  lungs,  from  the saliva becoming
 volatile and being inhaled.
     2d,  The application of the saliva to the surface of the
body.
     Sd, Through the stomach.
     The circumstance of the attendants of the sick in this
 disease escaping  it, although exposed  to  the exhalations
 from their bodies in the most concentrated form, and also
 to the contact of the saliva, argues very strongly against
 the first and the second.  With regard to its conveyance 
14
 through the stomach : besides that  the flesh of  rabid
 animals has been eaten with impunity ;  we  should con-
 clude from  analogy, that the disease could  not be im-
 parted through the stomach, from its having been ascer-
 tained by experiment that the venereal virus, the variolus
 matter, and the poison  of  the  viper can  be swallowed
 without injury, in this respect  differing materially from
 vegetable poison, which are  immediately hurtful  when
 applied to the stomach.
    It is now satisfactorily ascertained, that the disease
 can only follow the application of  the virus by means  of
 a wound or  an abraded surface j after however the virus
 is applied,  under these  circumstances a question arises,
 does it act immediately on the nerve, or  is it taken  into
 the system  by absorption ?
    During the reign of the humoral pathology when all
 diseases weie referred to certain morbid changes induced
 in the fluids, the lymphaticks were considered as the ave-
 nues through which substances  hostile  to  the healthy
 operations of the animal  economy found admittance into
 the body;  but  modern  physiology  has  discarded the
 ohymical notions of fermentation and assimilation ; the
 fluids arc considered of but secondary importance, and
 the nervous system believed to be the " seat and throne"
 of diseases,  as well as of the vital principle.  That the
 absorb entsare the  avenues through which contagion,
 infection, and indeed all poisons  assail the living system,
 is  an  opinion  that still  generally  obtains ; but the
 grounds upon which it  rests, are at least very problema-
 tical, if not  entirely untenable.
 The ingenious Dr. Cullen deviates from his usual path
of accurate investigation when he attempts, in treating of
 the  small-pox to found the whole pathology of the disease 
15
on the assimilating powers of the variolus infection.  Ex-
periments have demonstrated that the small-pox, and even
the venereal disease, cannot be communicated by means
of the blood.  Thus I  infer, not only from analogy, that
the canine virus is not taken into the system by absorp-
tion, but  from  the known operations of the absorbents
themselves which seem to possess a kind of discriminating
faculty and intelligence,* by which they separate substan-
ces that  are nutritious from those  that are excrcmenti-
tious and hurtful.   Experiments instituted with  a view
of detecting medicines in an active  state in the circula-
tion have failed; from which it would appear that no
substances can possibly enter  into the circulation unless
they had first undergone a digestive or assimilating (>ro
cess.   The mildest substances injected  into the arteries
have speedily thrown into disarray  all the  powers of the
system in these  animals on which  the experiments have
been tried.  But even admitting that the poison is taken up
by the absorbents; and that the system was not disturbed
immediately by any foreign substance being conveyed into
the circulation,  k should  seem from the length of time
which generally intervenes between the reception of the
bite and the accession of  the  disease, that the frequent
 revolutions of the virus with the fluids would change its
chymical qualities and render it inert or at least less potent
by dilution* or,  if  it  remained active,  that its deleteri-
ous influence would be exerted upon the glands through
which it must necessarily  pass ; which is not found to he
 the case.
    I  suppose, therefore, that  the operation of the poison
is  immediately  upon  the nerves  to which it may be
applied ;  its influence  being propagated by its specified
 powers along the course of the nerve until it invades the
                      * Hunter. 
16
 scnsorium.  The idea of Drs. Mease and Darwin of the
 ••virus  remaining local in  the part  injured  until some
 cause excites it into action," is, as it seems to me, at vari-
 ance with sound  sense, the disease having occurred after
 the part  bitten has  undergone frequent  and thorough
 ablutions, and indeed very frequently after  the  opera-
 tion of excision and the use of the caustick.   This was
 the case in one  instance in Alexandria,  and medical
 records afford many cases  to substantiate the fact.  The
 nature of all poisons  and indeed of the causes  of almost
 all diseases are  enveloped in obscurity:  on this  subject
 the severest philosophical  scrutiny has amounted only  to
 speculation and fanciful hypothesis, the  ingenious doctor
 Brown and his followers have  resolved the  setiology  of
 all diseases into a stimulant operation, whilst others admit-
 ting the existence of sedatives, deduce the pathology  of
 many diseases from this principle.  The former hold it
 as a fundamental principle, that " all  substances applied
 to the human body differ not in their  nature  but only  in
 the force, frequency, and diffusibility of their operation:"
 ibis principle may appear at the first view to be the result
 of faithful induction,  but from  strict analysis will be
 found to  be the offspring of false reasoning and contrary
 to our knowledge of facts.
    11 would scarcely, I think, be  asserted by the advo-
 eate-i of this system, that the mildest  nutritious  articles
 of diet and those that are considered as poisonous, are the
 same in their nature,  since under  every form of exhibi-
 tion one not more certainly destroys animal life, than the
 other supports and  perpetuates it.   Can there be disco-
vered any striking features of resemblance in the general
action of mercury and  of the preparations of lead andarse-
niek ?  Has the intermittent fever ever exhibited the phe- 
17
nomena of small-pox ;  the measles assumed the virulent
nature of lues, or  the rabies canina ever mellowed into
hysteria ?  If morbid changes,  therefore,  are uniformly
different in their features it seems absurd  to contend for
the identity of their causes, and hence our eonclusion is,
that the canine virus possesses a specifick  character of a
destructive or sedative nature which exerts its delete-
rious influence specifically upon the nervous system : in
thus supposing the  virus to have a peculiar and exclusive
bearing Upon the nervous system, we are supported by the
analogy of many other diseases, which apparently display
a kind  of elective attraction  for certain  of the general
systems of the body:  thus serophula and the lues venerea
entrench themselves in the lymphatick system ; the vari-
olus infection and  miasmata in the circulating, and the
scabies in the cuticular; and some  others extend their
empire over one or more, as the poison of the viper  and
of certain insects which effect  the arterial as well as the
nervous, but more  particularly the nervous system.  And
again,  certain medicines  which are "poisons given by
weight and  measure," exhibit a partiality for  certain
systems in preference to others—for  instance:  Mercury
holds an extensive  dominion over the lymphatick, asafce-
tida and castor the nervous, and digitalis the arterial sys-
tem.
    The operation  of  the canine virus in  producing  this
disease appears  to be successful or not so,  as there exists
a proclivity  in  the system or state of  predisposition to
favour it:  in what state of the nerves this may consist it
may be difficult to explain.   The  proposition is, how-
ever,  supported by the fact  that,  of a large number of
persons who have  been bitten  by dogs  labouring under
madness, a very small proportion become  affected by the
                           C 
                          18

 disease, although the circumstances in  which they have
 been placed have been precisely similar.  Of twenty cases
 that came .under the observation of doctor Hunter, where
 the virus had been ucceived from the same source, and in
 all of which no prophylactiek efforts had been made, only
 one  or  two fell victims to the disease.   This is confirmed
 by Dr.  Vaughanj  and. Van Swieten long agp remarked,
 if that the virus produced different effects upon different
 temperaments or constitutions," thus favouring the idea
 of the predisposition of the system being necessary to the
 production of the disease.         ■....'
   An  inviting state of the system appears to determine
 the accession of many other diseases, but: is  most obser-
 vable in tetanus, a very small number of those who are
 subject  to the causes of that disease becoming affected ;
 this can only be  explained by admitting  a state of predis-
 position, which predisposition may consist in a peculiar
irritability or mobility of the body, the disease- recurring
 more frequently  in those countries where the inhabitants
 are constantly exposed to the debilitating operation  of a
 vertical sun.   This predisposition I  believe  to consist in
 an atony or a deficiency of energy in the nervous system,
 for in proportion as the functions of the  body shall be
eneunibered or lessened in  their tone, in the same  ratio
 of facility will morhid causes exert their influence in the
 production of disease.  A remarkable instance in confir-
 mation  of this principle came under  my own observation,
 in the case of a girj of 17 or 18, who had been subject to
 epilepsy; she  was  attacked with the  bilious remittent
 fever to a violent degree, of which however she recovered ;
 hut during her convalescence her disease recurred  with
 aggravated violence, the. paroxysms now coming on every
day ; and I presume the observations of practitioners will 
19
furnish evidence sufficient to establish this proposition.
In this way I account for the fact mentioned in writers,   *
the canine madness occurring  immediately after the pa-
tient passed through other  diseases subsequently to the
reception of the bite.  The  various  and  indeterminate
periods of the accession of the disease are referrible to
the different degrees  of predisposition prevailing in the
bodies of the infected, together with the proximity of the
bite to the sensorium, which must be allowed to have no
inconsiderable influence, if the hypothesis of the gradual
progression  of diseased action from the  point Injured to
the sensorium,  be founded  in  truth.  Ancient as well as
modern  writers have mentioned, without commenting on
the fact, that wounds on the  superior parts of the body
are followed more certainly as well as more speedily b\
the disease, that those on the inferior portion  of the sys-
tem.  I  will add, that in symptomatick epilepsy, a morbid
change commences in the extremity of a nerve, and tra-
vels to the brain when a paroxysm succeeds.  This is not
useless speculation, but a principle from which a practi-
cal lesson may  be drawn in the method  of averting this
calamitous affection.
    That the canine 'virus exerts  its influence immedi-
ately on the sensorium  commune is deducible from the
most prominent features of the disease.  These, (as they
are displayed in the accession of the disorder,) are in most
instances a  yawning and  stretching,  horrinilatio, inapti-
tude  to motion, and  great prostration  of the spirits,—
signs strongly indicative of the lessened vigour of the ner-
vous energy. In the second place the excitability becomes
morbidly increased,  particularly  on the  surface of the
body, and constitutes  an exuberant source of torture  to
the unfortunate patient:  the slightest impulse, (in the ad- 
20
vanced stages of the disease,) occasions excrutiating pain;
the smallest breeze produces the  most violent writhings
and contortions of body, and the most inconsiderable exer-
tion  agitates  and convulses the  patient's whole frame :
this symptom is bold in its character and  universal in its
appearance, that it might almost  be appealed to as a
pathognomonick  sign of  this disease.  It arrested the
attention of the earliest observers of canine madness, and
has been remarked by every succeeding writer and prac-
titioner.   Cclsus remarked,  that shrill sounds disordered  «
the patient: Van Swieten observes, that clear and reflec-
ting bodies and the motion of the air were disagreeable
to patients, and indeed dreaded by them j  the agitations
of the air  occasioned by adjusting  the bed  clothes was
complained of by  one patient*.   Beumgaiton says,  that
injections,  even when the patient knew nothing of the
operation,  produced the most violent agitations.   In ano-
ther case, a drop of vinegar rolling on the patient's side
from a blister, produced the same violent effects ; and in
a case detailed by Dr. Physick,! confirmed by two which
eame under the1 observation of Dr. Dick, this  symptom
prevailed to a high degree : my own researches, indeed,
have not furnished me with a solitary  case in which this
symptom has  not been one of the most conspicuous :  this,
then, may be considered as another unequivocal sign, that
the nervous system is the principal sufferer from this poi-
son, and an indubitable evidence that,  it is the result of a
 debilitating operation.  The immediate effect of a stimu-
lant agent continued for some  time is  an exhaustion of
 excitability preceded by  violent excitement :  neither of
 these states is presented to us in this disease.  This mor-
* Medical Commentaries, vol. 3, p. 2%.
| Medical Repository. 
%\
 bid  irritability occurs in tetanus to  such a degree that
 the  smallest exertion as that of speaking, will  produce
 the  spasms.   Hysteria also exhibits the same phenomena.
 Dr.  Cullen observes, that persons liable to hysteria ac-
 quire such a degree of sensibility as  to be strongly affec-
 ted by the slightest impressions : this symptom has also
 been observed  in the last stage of malignant fever, not
 arising in this  case certainly  from an inflammatory dia-
 thesis prevailing in the system,  but indicating  here,  as
 in canine  madness,  the great prostration  of the  vital
 energies.
     Thirdly, convulsions—It will be obvious from some
 of the above phenomena, how connected and indeed de-
 pendent upon the morbid state of the nerves, is that state
 of the muscular fibre whieh disposes  them to irregular
 action.   I am  aware, that the doctrine of spasm and con-
 vulsion has been  drawn by some philosophers from the
 arterial system, and  has  been wielded  as an argument
 against the theory I am attempting to  support.  That
 high arterial action is sometimes a cause of convulsions,
 may be admitted;  but, even in this ease, the pathology
 of the disease will grow out of the nervous system, which
 predisposes it to be affected by this cause.  I think it is a
 principle in physiology which is established both by expe-
 riment and argument to which no valid objections can be
 reared, that the muscular fibres derive all their energies
 from the nervous system; disturb the function of a nerve
 and  the fibres are disordered: dissever their connexion
 and  they wither, although the circulation may be conti-
 nued ; the arteries themselves being only secondary in-
 struments.  Convulsions, therefore, must depend upon a
 morbid change in the  sources from which  the muscles
, derive their contractibility: the nature of this change we 
22
are perk a p- unacquainted with.   Persons suffering under
svncope, if kept in an erect position, will pretty certainly
fall into convulsions :  thus, in such oases, the prostrate
position is the remedy and will, if applied in season, effec-
tually prevent that unpleasant termination.  Any sudden
emotion or impression, as I have  said above, upon any of
the senses of hearing, seeing, or feeling,produced the most
violent  convulsions, and in these  cases the muscles  of re-
spiration are particularly effected, so as sometimes almost
to suspend that operation :  the contraction at other times
is so violent as to eject  the mucus from the mouth with
considerable  violence.   Celsus, compares the affection of
respiration " to what takes place  in boys unskilful in  the
art of swimming," (a happy illustration of what I shall
endeavour to  shew, gives occasion  to that distressing affec-
tion called hydrophobia :) in the  Medical Memoirs  there
is a case detailed in which universal convulsion was  the
consequence of the patient having been suddenly plunged
into a warm bath ; and every  case on the records of me-
dicine, furnishes evidences to the  same effect; therefore,
I think, that the convulsions  in canine madness, depend
upon the state of the nervous system.
    This state  of the nervous  system, may lead us to a
correct  rationaU of that symptom of this disease, which
has occasioned  so mnch speculation, viz. the  dread of
water, or more properly an incapacity of swallowing  it;
that this symptom may be referrible to the morbid exci-
tability  abo\e spoken of, especially as existing in the sen-
tient extremities of the nerves,  will appear from  what
has been advanced with regard to the convulsions being
in a great measure a consequence  of this state,  and  from
the same phenomena resulting  from  efforts to drink fluids,
or from  impressions or sudden emotions in some other way., 
23
Thus when a vessel of water is brought to the lips of the
patient, the impression occasions a sudden  emotion, ac-
companied with convulsions and a strong  inspiration of
air, which passing through the liquid, divides its particles
and produces  a spray which is drawn into the  windpipe,
and  strangles the patient;  hence, they are heard to ex-
claim, that their breath is taken from them by the effort
When the vessel is given to the patient himself, he brings
it to his mouth with  a hurried, agitated motion; and the
same phenomena are  exhibited.  In some cases, after the
patient recovers from the first impression, he can swallow
a considerable quantity without  being  disturbed, which
fact favours the  explanation I  have  given.  In propor-
tion, also, as  the substance approximates to the solid con-
sistence, is the facility with which the patient can swal-
low  it* as the particles of a solid substance cannot be so
easily separated by the sudden influx  of air : this was ob-
served by Celsus.  This symptom has been attributed to
a spasmodick affection of the muscles  of  deglutition : if
this were the case, the patient would be equally incapa-
ble of swallowing solids as liquids, which we know not to
be the fact, for solid k>od can almost always be swallowed,
and, consequently physicians do generally exhibit their re-
 medies in a solid form. In tetanus, where there is a spas-
 modick affection extending to the muscles of  deglutition,
 neither solids nor liquids can be taken  by the patient.
     These facts may not be unaptly applied  to another
 opinion as to  the  cause of this symptom, viz. that it
 arises from inflamatieu of the instruments  of deglutition.
 and indeed  the  whole respiratory apparatus,  and  upon
 which the sthenick nature of canine madness, has been at-
 tempted to  be  established.  But a moment's reflection
 upon the  phenomena of inflammation,  as they occur in 
24
 any of those organs, will satisfy, as no such phenomena
 oceur in canine madness.  Inflammation is a uniform and
 regular process, indicated always by heat, redness, pain,
 and swelling.   Therefore  the physical inconveniences
 arising from this state, would be constant  and uniform,
 whether its existence in the pharynx, trachea, or lungs.
But this uniformity does not appear in hydrophobia, the
patient can swallow solids without pain, he breathes with-
out difficulty or hoarseness, exeept during the paroxysms,
there is no pain in the thorax indicative of a state of in-
flammation :  in short, there occurs few, if any of the un-
equivocal signs of inflammation.  None of the marks of
inflammation have been discovered  from examination of
the throat during life, and, in a majority of cases, none
after death; and to conclude that it existed, because there
were some congestion of blood after death, would be un-
philosophical and unfair.  In  typhus fever marks of in-
flammation of the brain have been discovered after death ;
but will any person say that is  a sthenick disease ?  these
appearances may be  the result of a  disorganization in
articulo mortis ;  or, in cases of canine madness, from vio-
lent convulsions of the muscles of respiration.
    The state of the intellect would furnish  no slight evi-
 dence of the infection being such as I have suppossed.
    Arguments both for and against the sthenick nature of
 ihe disease have been drawn from the pulse :  the scale of
evidence, seems however to preponderate in favour of the
doctrine 1 have been attempting to support, viz. that the
 virus exerts its  paralizing  influence  primarily upon the
nervous system, in the effects of which, every part of the
body must eventually participate, until the sufferings of
 the patient are terminated by death, an event which the 
85
deadly energy of the virus  renders extremely preei-
pitate.
    I have glanced at the resemblance which this disease
bears to tetanus and hysteria,  the parallel might be ex-
tended, and furnish additional argument in support of the
above theory.
    The  method of treating tins  disease, will afford far-
ther evidence of its nature :  this I shall notice when I
come to treat of the cure.

            PROPHYLAXIS AN© CURE.

    JPROM  the most ancient  to the present  time, many
specificks lor the prevention and cure of  canine  madness
have been recommended, under the sanction of pretended
experience,  and maintained their credit for a  time, until,
upon the same ground, they, have been rejected as ineffec-
tual : thus the cold bath of Celsus, (which is  not yet ex-
ploded,)  Dampier's  powder, the Turpeth mineral, the
Tonquin ormskirk  medicines, have  each in their  time
been recommended as specificks.  A species of anagalis,
or chick weed ; one of the most inert and insignificant ve-
getable's, has acquired celebrity so great, as to have gai-
ned the patronage of the  Pennsylvania legislature, and
under whose auspices has been resorted to by alljwho ap-
prehended, or laboured under canine madness; with what
success, k  attested  by the melancholy evidence of num-
bers who fell  victims to the  disease, after depending
on  this trifling  nostrum for prevention, at that period
when more 4eeisive measures  might have been used with
a probability of success.   The credit of specificks is not,
however, surprising  when  we remember how few  <rf
                          D 
26
those who received bites,  are attacked with the disease,
even when no remedy whatever has been applied.
    The attention of physicians, is now however, directed
to two methods of preventing this disease.  First, the use
of mercury, and secondly, excision or destruction in any
other way, of the  part to which the poison has been ap-
plied.  Mercury was very early resorted to by physicians.
Those of France recommended it, both as a prophylactick
and cure, and urged the use of it, with a view of opening
the pores, and eliminating the  poison from the body.—In
1756, Claude de Choisel  sent in a paper to  France on this
subject : M. Desault, M. Tauvrey, Cheyne and Sauvage,
recommended its use in papers, sent to the  college of phy-
sicians, and in  pamphlets published to the world ; but
subsequent unhappy experience has demonstrated it to be
a very doubtful prophylactick, if not an entirely useless re-
remedy ; for there are some cases upon record,  in which
the disease occurred, although the  patient was at that
time labouring under ptyalism, from the extensive use of
mercury.
    The other method  mentioned, is that only in my opi-
nion,  by which  we can  have any hope of arresting this
awful calamity, viz. destroying the part injured.  Though
spoken of by the ancients, it only has been relied upon by
ihe moderns.  It must, however, be acknowledged, that
even this measure has in some instances failed ; but these
failures have arisen, from the destructive process  not ha-
ving been carried to a sufficient extent,  as will  appear
evident from a  review  of the manner in which I have
supposed the poison to act, viz. that the first impression
is of a sedative  nature,  and that this effect is propagated
along the course of the nerve, towards the sensorium, with
more or less facility, in  proportion to the degree of direct 
27
debility prevailing in the system. If this then be correct,
which I am inclined to believe is the case, it is clear, that
in order to prevent the occurrence of the disease, the des-
tructive process must extend beyond the sphere  of the
paralyzing power  of the poison: this will be known by
the  appearance of inflammation and suppuration, which
indicate that the energy  of the system is successfully
exerted against the invading  disease.   The  case  that
occurred  in Alexandria alluded  to, when  speaking of
the  manner in which the poison affected the system, de-
monstrates, as far as one case can, the truth of the above
theory.  Here caustick, both in a solid and liquid form.
was applied to  the patients hand, (for the bite was be-
tween  the thumb  and finger,) and was the only injury re-
 ceived ;  but the wound was   completely insensible, al-
 though it was bleeding freely  before the application of
 the caustick.  A scar  formed and was removed, without
 any  sign of inflammation or suppuration, and  this conti-
 nued to be the case, although the caustick was applied  a
 second and a third time: six weeks after, the patient took
 the disease and died.   In this instance, the sensibility of
 the adjacent parts was evidently destroyed, by the virus,
 and the system was not saved,  because the  application of
 the caustick did not reach the extent of the affection.  The
 favourable  prognosis,  it would  seem, would have been
 drawn from a different result, that is, sensation and in-
 flammation, by which  the paralyzing power of the virus
 would have been arrested.  On this ground I account for
 the  result before mentioned, of the  disease following
 more certainly when  the virus was applied to a  small
 wound, than when to alar^e one ; a large wound  making
 a potent demand upon the energies of the system,  both in-
 flammation and  suppuration more commonly ensue, and
* 
«8
on the production of these our prophylaxis depends. Let
it net be said that the disease  has occurred even after the
wounds have inflamed, unless it be ascertained that all
the injuries which the  person received were followed by
inflammation.  The smallest injuries are those that are
most likely to  escape notice,  and  are most probably
Jbe  avenues through   which  the  system   is  affected.
In communicating the sUiall-pox by inoculation* it is be-
lieved to be most effectual  to  make the incision so small
as to excite as little inflammation  as possible : so also
with the vaccine virus; and doctor  Pearston has said that
if an inflammatory diathesis could be induced in the sys-
tem  the canine  disease would be prevented.
    Many methods  have been proposed of destroying or
removing the part injured, scarification, excision and the
actual and  potential eaUtery.   Scarification, as, it does
not comprehend all  the  part injured, cannot be sufficient,
the  actual  cautery  is  too  barbarous, and  is rendered
unnecessary by the refinements of modern surgery.   The
knife may  be  substituted in  many instances where ih«
injury is in  deep muscular parts with very great propri-
ety,  but to the knife there are some  strong objection*:
under  certain  circumstances,  the  dread it  occasions in
delicate persons is extreme.  Sometime*, indeed, the knife
eanflot be used, as in the neighbourhood of blood vessels
of considerable size,  and m tendinous part*.  The caustick,
therefore,  may be  used in preference* and  the caustick
vegetable alkali, as  directed to be  prepared  and usedty
Dr.  Wllkins of Baltimore, ought to he preferred :  it has
the advantage of being insinuated into the fnterstfeet, of
the muscular fibres and cellular subt**nee>  and thus is
more likely to derrroy  all the parts that may Imve beea
Injured by the  poison.  Some auxiliary means should be 
*9
   attended to:  the patient should avoid excess of all kinds,
   and habits and practices that might induce  debility; and
   unnecessary  exposure to the weather;  and  the system
   should be sustained at its proper tone by nutritious and
   generous diet, together with the occasional  use of tonics.
       To retrace the varied and unsuccessful methods >hieh
   the ancients  resorted to, governed  by the vicissitudes of
   false theory, in order to cure this disease, would be a task
   as difficult as the result would be unprofitable, and the
   imbecility of modern preventives  serves only to exhibit
   melancholy evidence of the imperfection of medical sci-
   ence ;  for to attribute any failure to the incurable nature
   of the disease, would be doing violence to our ideas of the
   benevolence of that being  who  has ordained that good
   should be commensurate with evil,  and who has, no doubt,
   enriched the stores of nature with an antidote for every
   poison;  two methods, as opposite  in their nature as the
   theories whieh gave them rise, are now  resorted to by
   physicians for the cure of canine madness.   One class of
   physicians, believing the disease to be of the highest de-
   gree of sthenick action, have directed the antiphlogistic^
   regimen iu its fullest extent, without however realizing
   a favourable »esult.   The instances demonstrating the in*
   efficacy of this plan  of treatment,  are very numerous, it
    having  been employed to  a greater or less extent by
   physicians generally, ever since the time of  the celebra-
   ted Boerhaave, who advises the extensive use of the lan-
    cet, although he appeared  to be dissatisfied with the me-
   thod.  Doctor Johnstone details a  case, in  whieh seventy
    six ounces of Wood  were drawn,  without  producing anjr
    abatement of the symptoms.*  There is another detailed
    in the Medical essays,! in whieh, after the first bleeding,
      * Memoirs, Med. Soc. Lond. vol. 1, p.  2*3-
      f Medical Essays, vol. 6.
r 
30
the uandage came off, and  could  not be  secured for an
hour,  during which time  the patient lost an immense
quantity of blood without any  salutary change ; and in
the cases published by Drs.  Physic and Rush the lancet
was used freely without ameliorating the condition of the
patients.*  I have already taken notice of mercury  as a
prophylactick, and I then also glanced at its use as  a re-
medy.   It  is to me very doubtful whether any dependence
can be placed upon it in this  capacity.  From  the rapid
progress of the disease, the alterative effects of this me-
dicine never could be produced, and if they could,  yet,
reasoning upon the ground of its not being inflammatory,
it would  seem to be rather an auxiliary to the ravages of
the disorder by reducing the powers of the  system. There
are some instances upon record, as I  have before men-
tioned, in which the  disease  occurred whilst the patient
was labouring under  ptyalisni.!
   Another class of physician  have pursued a  different
method of treatment derived from a more correct view of
the nature of the disease.  From the phenomena as  pre-
sented in the foregoing pages, arise two principal indica-
tions.  The first:  to lessen  or remove  the morbid exci-
tability of the whole system, and of the surface particu-
larly :  and the second,  to excite the energies and main-
tain the tone of the nervous system, and thus arrest the
progress  of the disease.  Important  advantages would
result from accomplishing the first  intention as  facilita-
ting the use of the means necessary for  attempting  the
second.   The presence of hydrophobia must ever be an
awkward impediment in the way of a successful treatment
* Medical Repository, toI. 5, No. I.
f Medical Commentaries, vol. 12, p. 304. 
31
of the canine madness, which, together with all the con-
vulsive affections attendant upon the disease.  I have re-
ferred to a morbid excitability  of the nervous system___
Such methods, therefore, should be  resorted to as will
most speedily effectuate this object. Sheathing the highly
excitable surface by an  oleaginous covering promises to
fulfil this intention  with the most  flattering  success.—
Celsus, long ago spoke of a bath of oil being eminently
serviceable in this  disease, and benefit might have been
expected to  have resulted upon theoretical  grounds or
from the advantages that have been derived from the use
of oil in other affections in which the excitability is  mor-
bidly increased,—-as in convulsions  from worms, hyste-
ria, ccc.  But the  success of this method was realized under
the  management of doctor JDick  in  canine  madness, in
1803, occurring  in the case  of  a person by the name of
Cole,  from  the bite of a cat received about five or six
weeks prior to the attack ; and, as far as a  single  case
can warrant an expectation of similar results, this is clear
and conclusive.
     The doctor had waited for some years with consider-
able solicitude for an opportunity of trying the efficacy
of some  covering which  should  completely  shelter the
whole external surface from the action of the air, with a
view to  correct the affection called hydrophobia.   The
disease was  perfectly established,  and  every attempt to
swallow liquids excited the  usual agonies.  Melted tal-
low in a lukewarm state  was speedily applied by means
of a painter's brush to the whole surface of the body, in-
cluding  the head and face.  Instantaneously  as the pro-
cess was completed, the patient drank a glassful of wa-
ter without any other difficulty  than what seemed to arise
from apprehension upon commencing the experiment. It 
52
 was now evening, and the  doctor left  him  under very
 grateful impressions,  and a  lively hope that he  might
 witness a solitary cure of this terrible malady.  His avo-
 cation? afforded him uot another opportunity of seeing his
 patient till towards the middle of the  following day $
 when, to his great grief, he ffuod  the  hydrophobia re-
 turned in fall force, and the disease advancing to its usual
 termination.  The coat of tallow had  been  rnbbed off
 during the utgttC  Bread bandages were new obtained, suf-
 ficient to envelop the  whole body,  head, trunk,  and ex-
 tremities.   These being previously -dipped m melted  tal-
 low, combined 'with a  small  portion of bees-wax, were
 then carefully applied, beginning  with the lower extre-
 mities separately, and proceeding upwards.   As soon as
 Ike process was completed the result was as in the former
 case.  The patient drank freely without difficulty,  and
 ate whatever his appetite required.   Hope was again re-
 vived: but  although  ftydrophobia never  returned,  nor
 any of those horrible characters of canine madness, he
 survived but a day or two. He lay in the mean time quiet
,and tranquil, gradually sinking till «he vital principal be-
 came extinet  The doctor has had to regret, that  the
 occurrence of this case shonld have been during the pre-
 valence of yellow-fever in Alexandria, in the management
 of whieh he had a press -of employment  'which deprived
 him  of the opportunity of devoting either the time or at-
 tention to it which the circumstances  related, so peculi-
 arly and strongly demanded.
     The obstacles to exhibiting medicines,  having  been
 removed in fulfilling the first indication, the second may
 he best accomplished by a prompt and  extensive use of
 the  most powerful remedies of the touick and stimulant
 class ; for the ill  success whieh has attended this plan of 
S3
treatment, appears to me to be derivable in a great mea-
sure, from the difficulty which attended the exhibition of
medicines, as copiously  as the violent nature and rapid
progress of this disease demanded, or even, indeed, to the
extent which would have been deemed requisite in a much
milder  disease.  Therefore,  after  having cleansed the
prima via*, by a proper evacuant, as calomel,  which may
be useful in removing infarctions of the abdominal viscera,
opium and wine should he resorted to,  as being most im-
mediate and  diffusible  in their operation,  and should be
exhibited in such quantities, as shall Ibe sufficient to keep
up  a  high degree  of excitement: the  volatile  alkali,
Kther and alkohol, may be resorted to in aid of the fore-
going as may be found necessary.   The  propriety of rely-
ing  principally upon opium and wine,  will appear from
the success attendant on the very large use of these me-
dicines in tetanus, in the West Indies  and in this coun-
try, which has  indeed  been  almost unparalleled.  The
force or quantity of these several remedies, to be regula-
ted according to our view of the superior rank  which
canine madness occupies above tetanus.   Doctor Wolf, of
Warsaw, relates a case of canine madness in which this
plan succeeded, but it was carried to a very great  extent,
for the patient, in  forty-eight hours, took two bottles of
brandy,  with the same quantity of  oil, together  with a
large quantity of opium and castor ! !  Dr.  Nugent re-
lates a case  that terminated favourably ! in which the
stimulant remedies  were principally relied upon.  And
there is another case detailed in Wilkenson on  galvanism !
in which the galvanick  influence received from  a most
powerful battery proved successful. 
 
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