The Sun.
London, England, 1824-01-05 00:00:00

iirDROPHOBIA.

HISTORY OF A CASE OF HYDROPHOBIA, TREATED AT
THE HOTEL DIEU AT PARIS, R 1 INJECTION OF
'WATER INTO THE VEINS. BY R. MAOENDIE. (OCTO-
BER, 1823.)
On the 15th of this month I Was invited by
R. Caillard, the resident Physician at the Hotel Dieu, to go
immediately to that hospital, to give my opinion on the case
of a man who had just arrived in the last stage of the Hydro-
phobia- 1 went at one o'clock. Several pupils of the hospital
who in I Met, told me that there was not a moment to lose, if
I wished to see the patient alive. When I arrived, I found the
patient Placed in an isolated room, restrained by a strait waist-
coat, and agitated by the most furious transports; on approach-
ing his bed, I found that he exhibited all the symptoms of
hydrophobic mania; the eye menacing, but not injected ; the
most violent cries and efforts (1) to get rid of the straps which
held him down; alteration of the voice, thickened saliva, biting
at the substances which were presented to his mouth, and at in-
tervals a return to a tranquil state. At these intervals, which
lasted a very short time, he understood the reasons and the con-
solations which were addressed to him, but he soon relapsed into
a state of fury. The sight of a looking-glass, or of any liquid,
excited the most violent agitation. In the morning he had
swallowed a few drops of liquid, but when 1 saw him, a spoon-
ful of water which was poured within his lips, produced dread-
ful convulsions in the muscles of the pharynx, and he spat it
out violently upon the assistants. The slightest noise, even the
mere cnntact of the fingers with his hair, produced convulsions
of incredible violence. His body bent . and unbent itself al-
ternately with an energy which it was difficult to account for.
His pulse beat more 'than 150 strokes in a minute, and his
respiration was interrupted. From all these symptoms, there
could be no doubt as to the existence of hydrophobia ; it was
evident that the patient was on the point of death.

I inquired whether the man had been bitten ; and was told
that his relations knew nothing about such a circumstance. It
appeared that the patient had been in low spirits for some time,
bemire he had not strength enough to continue his business as
a jot;neyrnan baker ; that his
,melancholy had increased since
the receipt of a letter from a woman to whom he was passion-
ately attached; that two weeks before he had tried to drown his
cares by excessive drinking, which lasted several days, and that
the consequence of his excess was a copious bleeding from the
nose, for which he consulted a physician, who considered his
case to be a congestion of the brain ; and ordered thirty leeches
to be applied, after having bled him from the arm three times.
Notwithstanding this treatment, the patient was seized with
several paroxysms of fury, in which he threatened all who were
near him, and swallowed liquids with difficulty. His relations
finding that his disorder increased, and not being able to re-
strain him, brought him to the Hotel Dieu in the night. I learnt
also that the patient had been copiously bled in the foot at the
hospital that morning without any abatement of the parox•
yams, which followed each other more rapidly, and increased
I,
greatly in violence.

The greater part of this information coincided with the ex-
istence of hydrophobia I requested a dug to be brought, in or-
der to inoculate it with the saliva of the patient, and repeat an
experiment which I. had formerly made at the Hotel Dieu in
concert with M. Breschet. (2)
In the mean time the case was of the most urgent nature, and
it was evident to all present that the patient would very soon
sink under the violence of the disease. Already a cold sweat
covered his forehead and breast, and his pulse could scarcely
be counted. It became necessary, therefore, to take decided
measures.

I recolldcted the results of the experiments which I have re-
corded in the first volume of this Journal, and in which I had,
seen the phenomena of hydrophobia cease in dogs, by the injec-
tion of warm water into the veins ; ii determined, therefore, to
try this extreme measure. (3)
A small syringe for hydrocele, in a very indifferent condi-
tion, was brought to me ; some water war heated to 30 de-
grees (Reaumur); I ordered the right arm of the patient to be
siezed, and I exposed it by making an incision in the sleeve of
the strait waistcoat. I was immediately struck by several little
wounds which appeared on the index, and a much larger size
scar on the second bone of the metacarpus, which appeared
to be the effect of a recent application of the cautery. The pa-
tient was not in a state to answer any question, and his friend,
not having been able to give me any information on this sub-
ject, I proceeded to open a vein in the fore-arm. This opera-
tion, generally so simple, was in this case rendered somewhat
difficult, in consequence of the continual motion of the patient.
However, five or six strong pupils having seized his arm, I
succeeded in passing two threads under the vein, and made an
opening in it which enabled me to introduce the mouth of the
syringe. It was a quarter past one o'clock when I began to
inject into the vein, the quantity of two pounds of water, at

PRICE SEVEIIiTgCC‘.

thirty deg (Reaumurk having tepleniehed the syringaishi
times.
Every time I injected a jireogefilit of tinter,tinter,;ercatput*til
patient to see Whether him" r relit ted Jahji 'Alva Watch mcgL
iuduce me to suspend the.injectioi.i. 4314 There .was nO pmt,
calm change ; he: continued to yaziferate, and. to talk nf. hi
inevitable dissolution, &c.; only stopped because A goiteciV
ed that I had ejected enough to- prodUcc a sensible effect.
, The injection was concluded at .411 minutes. pat oao.
cured the vein above and below, the wound,
..Akeeady env)
expected degree of tranquillity *1.3 °Waved in the patient';
iii
pulse was sensibly diminishing it fell from 150 to IN •
after to 100; and twenty. minutes had scareely elapsed bc:forei
fell to 80. At'this time we ohserved a phenotnenttri
-one had ventured to hope ter; all the acute and viorent symp
toms disappeared, with a peottiptitude which astonished
ai
who witnessed it; I, felt at this moment the highest satisfar-
tion which I have ever experienced.
The patient regained the tiAe of his reason ; his fury tar:
succeeded by perfect tranquillity.; his eyes recovered. their ne.
tural expreasion ; the convulsive, motions vaaard 4. and what
most extraordinary, he was, able to drink without any diffleult;
a glass of water Whichi was presehted to hitn;"'in shoit.,
the
state of the patient had undergone comp 'et c}tange. Soon
after, Calliard caused the strait. waistcoat is be removed freer
the patient, who immediately a4it:-:1 pertnis:.iieri to get ep, am;
,go down into the court to make water. It was'tnought ft)]
some time that the. request was she effect of sonic remains el' deli.
rium, but he repeated it so often, and in so.preeising.a manner
that 111. Caillard at length consented to it, and ^as astonishe
s
to see the patient, supported by the pupils, welk calmly to-
wards the door. When it was found • that hereally wanted -
tt
make water, he was told tal
hat he had better do. so its a corner
the room. A few minutes after, he passed ti!eetat a pint el
urine troubled, of a deep yellow colour, and so extremely fetid
that it was necessary to carry it away immediately from the room.
At this tithe, Which was an hour and a half after the iojec tion,- the patient asked for his relations, saw then, conversed
with them on his affairs, and resumed his courage, and his
hope.
The physical state of the patient at this time was very re-
markable, and resembled nothing I have , ver witnessed. He
had no fever; his pulse scareely.exceeded 80 ; but all the func-
tions which support life; the contractions 'oftlie heart, respira-
tion, &c. were performed With a quick tremor. If we touched
any muscle, we felt it agitated by the same tremor; in short,
the morbid phenomena in this patient were as singular as the
novelty of his condition.
In the evening of the 17th, he received the succours of reli-
gion. In the night he had hemorrhage of the large intestines ;
the blood came out in clots of nearly a cubic inch, and had the
appearance of arterial blood ; it was mixed with portions of
well-formed fecal matter. A little pain-in the abdomen follow-
ed this accident; but it was calmed by. emollient clysters and
fomentations.
This patient was able to take some chicken broth. He con-
tinued to get better without interruption till the fifth day ; on
that day he complained of acute pains in the wrists, knees, and
and elbows. The left knee especially was swelled, and
the elbow and wrist on the same side. Besides these in-
flamtnatory accidents, which had evidently no connection with
the original disease, and probably rose with the method of
bleed him copiously in the foot.—
treatment, the patient laboured under another complaint. On
laird -
The
bleedingjud d it
ansecoees;taiirrYmetod during the most violent state of
the morning that he was brought to the Betel Dieu, M. Cail
the symptoms, and the motions of the patient bad caused the
points of two ancets to be broken in the inn. r side of the tibiae
These extraneous bodies had excited a violent inflammation,
of the foot and of the posterior parts of the leg, and there was
every reason to believe that a large abscess had formed in this
part.

These different local accidents contributed to threaten the like of the patient; in addition to these, involuntary vomiting of
green matter supervened, the abdomen was painful to the touch
towards the ccecutn, and fever began to appear. Some persons
said incautiously before the patient that he had been bitten by
a mad dog, and that an experiment bad been made upon him.
From that time hiS mind became sensibly affected • he despair-
ed of obtaining' a cure, and was constantly in apprehension that
some person was corning to smother him. At length on the
eighth day after the mje:tion, no hope of a cure remained,
and he died early on the ninth day. There was nothing parti-
cular in the manner of his death ; he was sensible that his
death was approaching, and he dozed a little before his disso—
lution:'
The body was opened in the presence of a great number cf
practitioners and students.
Our attention was first directed to the local accidents which
had evidently caused the death of the patient we expected to
find a large abscess in the posterior part of the right leg ; and
we did in fact find one occupying the space between the projec-
tion of the calf and the leg.
We then examined the swelled joints which had occasioned,
such severe pain to the patient, namely the knee, the elbow.,
and the wrist of the left side We found all these joints filled
with pus, anti their synoria in a state of violent inflammation.
The cartilages, as it often happens, did not participate in this
inflammation.

We did not expect to find any severe lesion of the intestinal
canal; there was no remarkable appearances in this partenever-
theless the hemorrhage by the anus, the pain felt 'by the patient
which obliged us to have recourse to emollients, shewed that
the digestive organs were not in a sound state ; and accordingly
we found the mucous membrane at the end of the small intes-
tines red by the injection and expansion of its veins. -This
redness, though less strongly marked, reached as high as the
jejunum. At the junction of the ilium with the ceecum there
were a dozen little superficial and recent ulcerations; the
largest were a quarter of an inch in length, and one-sixth in
breadth ; and the corresponding mesenteric glands were but
little swelled, without any alteration of their structure--a cir-
cumstance which proves that they were very recent. There
was nothing remarkable in .the large intestines from which the
hemorrhage had cereinly proceeded. The pharynx, cesopha-
gas, and stomach, presentCd nothing worthy of observation.
But a general phenomenon. which was very remarkable, was
the decided state of putrefaction in which we found the blood.
This fluid was every where liquid, and had furnished a great
quantity of gate which filled and distended the heart and large
vessels, anu had produced sub-peritoneal emphysema of the
stomach and intestines. The lungs were sound, though a little
swelled in their posterior part ; the last bronchial divisions were
red, but the trachea was sound. (4.)
Nothing particular was observed in the nervous system.
Some reddish serum was seen at the base of the cranium, and,
in the vertebral canal. The veins of the braie, eLd of the
rachidian prolongation, were fined with red liquid bleed. The
ganglions of the grand sympathetic were in a natural state._
The little wounds and scar of the hand were also examined
with the greatest care, zed all the medical gentlemen present
were struck with the resemblance of these wounds to oitee, a;.;il
of the scar to the effects of the recent application of the cautery.
It results from the history of this ease, that a disease, which
exhibited all the characters cf hydrophobia, ceased by the
introduction of a pint of warm water into the veins; 'that the
patient survived this introduction ;eight days ; that no accident'
appeared to follow from it ; and that the death of the patient
appears to have been caused by a local disease, which was-
wholly unconnected with the hydrophobia, and the new mode of"
treatment.
The hope of succeeding in a means of curing . hydrophobia,
by the injecting of warm water into the veins, already founded
on some experiments made upon animals, acquires therefote a
fresh degree of probability. • It is even possibleeas some of my'
learned brethren of the Hotel Dieu think, that the same means
may become a resource in certain extreme cases, in which the
ordinary medical treatment is unavailing.
With a view of enabling practitioners; of all 'countries to
make experiments themselves, I shall publish in the next num-
ber what experience has taught Me, with respect to the advan-
tages or injurious effects of the injection of warm water into-the
circulating system.—( Lancet.) ..
(1) In these attempts he had torn, with his tee.:2l, a part of
the strait waistcoat which he teas eble reach.
<2) The inoculation did not take place, as we multi not pro-
cure a sufficient quantity of saliva from 'the patient to per-
form it.. •
(3) If the case had not been of so pressing a nature,. i should
have considered it my duty to consult my learned brethren at
the Hotel Dieu, and I should have confined Myself to merely
proposing the measure, which, under the c'rciuntances, I felt
it necessary to resort to iminedictely. '
(4) The rapid putrefaction of the blood, and the consider-
able development or gas in th'e vessels, and heaete are almost
always observed in the bodies of individuals and t9:iirpgls that
have died of hydrophobia. In hot weather this appetikeance is
very striking an hour 'after death. In•this point of vieiv, the
excessively foetid state of the urine passed by theyetientetftera
the injection, is worthy of observatien. • '