Part 19

After a violent Rheumatism, People should long be careful to avoid that cold and moist Air, which disposes them to relapse.

Sec. 185. Rheumatic People have too frequent a Recourse to very improper and hurtful Medicines, in this Distemper, which daily produce very bad Consequences. Such are spirituous Medicines, Brandy, and Arquebusade Water. They either render the Pain more obstinate and fixed, by hardening the Skin; or they repell the Humour to some inward Part. And Instances are not wanting of Persons who have died suddenly, from the Application of Spirit of Wine upon the Parts, that were violently afflicted with the Rheumatism. It also happens sometimes that the Humour, having no Outlet through the Skin, is thrown internally on the Bone and affects it. A very singular Fact occurred in this Respect, an Account of which may be serviceable to some Persons afflicted with the Disease. A Woman at Night was chaffing the Arm of her Husband, who had the Rheumatism there, with Spirit of Wine; when a very lucky Accident prevented the Mischief she might have occasioned by it. The Spirit of Wine took Fire from the Flame of the Candle she made use of, and burned the diseased Part. It was drest of Course, and the Suppuration that attended it, entirely cured the Rheumatism.

Sharp and greasy Unctions or Ointments produce very bad Effects, and are equally dangerous. A Caries, a Rottenness of the Bones, has ensued upon the Use of a Medicine called, The Balsam of Sulphur with Turpentine. I was consulted in 1750, three Days before her Decease, about a Woman, who had long endured acute rheumatic Pains. She had taken various Medicines, and, among the rest, a considerable Quantity of a Ptisan, in which Antimony was blended with some purging Medicines, and a greasy spirituous Balsam had been rubbed into the Part. The Fever, the Pains, and the Dryness of the Skin soon increased; the Bones of the Thighs and Arms became carious: and in moving the Patient no more than was necessary for her Relief and Convenience, without taking her out of her Bed, both Thighs and one Arm broke. So dreadful an Example should make People cautious of giving or applying Medicines inconsiderately, even in such Diseases, as appear but trifling in themselves. I must also inform the Readers, there are some rheumatic Pains, which admit of no Application; and that almost every Medicine aggravates them. In such Cases the afflicted must content themselves with keeping the Parts affected from the Impressions of the Air, by a Flanel, or the Skin of some Animal with the Fur on.

It is also more advisable sometimes to leave a sufferable and inveterate Pain to itself, especially in old or weakly People, than to employ too many Medicines, or such violent ones, as should affect them more importantly than the Pains did.

Sec. 186. If the Duration of the Pains fixed in the same Place, should cause some Degree of Stiffness in the Joint affected, it should be exposed twice a Day to the Vapour of warm Water, and dried well afterwards with hot Linen: then it should be well chaffed, and lastly touched over with Ointment of Marsh-mallows. Pumping, if superadded to this Vapour, considerably increases its Efficacy. I directed, for a Case of this Sort, a very simple Machine of white Tin, or Lattin, which combined the Application of the Steam and the Pump.

Sec. 187. Very young Children are sometimes subject to such violent and extended Pains, that they cannot bear touching in any Part, without excessive Crying. We must be careful to avoid mistaking these Cases, and not to treat them like Rheumatisms. They sometimes are owing to Worms, and go off when these have been discharged.

_Chapter XII._

Of the Bite of a mad Dog.

_Sect._ 188.

Men may contract the particular and raging Symptom, which is very generally peculiar to this Disease from this Cause, and even without any Bite; but this happens very rarely indeed. It is properly a Distemper belonging to the canine Genus, consisting of the three Species of Dogs, Wolves, and Foxes, to whom only it seems inherent and natural; scarcely ever arising in other Animals, without its being inflicted by them. Whenever there occurs one of them who breeds it, he bites others, and thus the Poison, the Cause of this terrible Disease, is diffused. Other Animals besides the canine Species, and Men themselves being exposed to this Accident, do sometimes contract the Disease in all its Rage and Horror: though it is not to be supposed, that this is always an unfailing Consequence.

Sec. 189. If a Dog who used to be lively and active, becomes all at once moapish and morose; if he has an Aversion to eat; a particular and unusual Look about his Eyes; a Restlessness, which appears from his continually running to and fro, we may be apprehensive he is likely to prove mad; at which very Instant he ought to be tied up securely, that it may be in our Power to destroy him as soon as the Distemper is evident. Perhaps it might be even still safer to kill him at once.

Whenever the Malady is certain, the Symptoms heighten pretty soon. His Aversion to Food, but especially to Drink, grows stronger. He no longer seems to know his Master, the Sound of his Voice changes; he suffers no Person to handle or approach him; and bites those who attempt it. He quits his ordinary Habitation, marching on with his Head and his Tail hanging downwards; his Tongue lolling half out, and covered with Foam or Slaver, which indeed not seldom happens indifferently to all Dogs. Other Dogs scent him, not seldom at a considerable Distance, and fly him with an Air of Horror, which is a certain Indication of his Disease. Sometimes he contents himself with biting only those who happen to be near him: while at other Times becoming more enraged, he springs to the right and left on all Men and Animals about him. He hurries away with manifest Dread from whatever Waters occur to him: at length he falls down as spent and exhausted; sometimes he rises up again, and drags himself on for a little Time, commonly dying the third, or, at the latest, on the fourth Day after the manifest Appearance of the Disease, and sometimes even sooner.

Sec. 190. When a Person is bit by such a Dog, the Wound commonly heals up as readily, as if it was not in the least poisonous: but after the Expiration of a longer or shorter Term, from three Weeks to three Months; but most commonly in about six Weeks, the Person bitten begins to perceive, in the Spot that was bit, a certain dull obtuse Pain. The Scar of it swells, inflames, bursts open, and weeps out a sharp, foetid, and sanious, or somewhat bloody Humour. At the same Time the Patient becomes sad and melancholy: he feels a kind of Indifference, Insensibility, and general Numbness; an almost incessant Coldness; a Difficulty of breathing; a continual Anguish, and Pains in his Bowels. His Pulse is weak and irregular, his sleep restless, turbid, and confused with Ravings; with starting up in Surprize, and with terrible Frights. His Discharges by Stool are often much altered and irregular, and small cold Sweats appear at very short Intervals. Sometimes there is also a slight Pain or Uneasiness in the Throat. Such is the first Degree of this Disease, and it is called by some Physicians the dumb Rage, or Madness.

Sec. 191. Its second Degree, the confirmed or downright Madness, is attended with the following Symptoms. The Patient is afflicted with a violent Thirst, and a Pain in drinking. Soon after this he avoids all Drink, but particularly Water, and within some Hours after, he even abhors it. This Horror becomes so violent, that the bringing Water near his Lips, or into his Sight, the very Name of it, or of any other Drink; the Sight of Objects, which, from their Transparence, have any Resemblance of Water, as a Looking Glass, &c. afflicts him with extreme Anguish, and sometimes even with Convulsions. They continue however still to swallow (though not without violent Difficulty) a little Meat or Bread, and sometimes a little Soup. Some even get down the liquid Medicines that are prescribed them, provided there be no Appearance of Water in them; or that Water is not mentioned to them, at the same Time. Their Urine becomes thick and high-coloured, and sometimes there is a Suppression or Stoppage of it. The Voice either grows hoarse, or is almost entirely abolished: but the Reports of the bitten barking like Dogs are ridiculous and superstitious Fictions, void of any Foundation; as well as many other Fable, that have been blended with the History of this Distemper. The Barking of Dogs however is very disagreeable to them. They are troubled with short Deliriums or Ravings, which are sometimes mixed with Fury. It is at such times that they spit all around them; that they attempt also to bite, and sometimes unhappily effect it. Their Looks are fixed, as it were, and somewhat furious, and their Visage frequently red. It is pretty common for these miserable Patients to be sensible of the Approach of their raging Fit, and to conjure the Bystanders to be upon their Guard. Many of them never have an Inclination to bite. The increasing Anguish and Pain they feel become inexpressible: they earnestly wish for Death; and some of them have even destroyed themselves, when they had the Means of effecting it.

Sec. 192. It is with the Spittle, and the Spittle only, that this dreadful Poison unites itself. And here it may be observed, 1, That if the Wounds have been made through any of the Patient's Cloaths, they are less dangerous than those inflicted immediately on the naked Skin. 2, That Animals who abound in Wool, or have very thick Hair, are often preserved from the mortal Impression of the Poison; because in these various Circumstances, the Cloaths, the Hair, or the Wool have wiped, or even dried up, the Slaver of their Teeth. 3, The Bites inflicted by an infected Animal, very soon after he has bitten many others, are less dangerous than the former Bites, because their Slaver is lessened or exhausted. 4, If the Bite happens in the Face, or in the Neck, the Danger is greater, and the Operation of the Venom is quicker too; by Reason the Spittle of the Person so bit is sooner infected. 5, The higher the Degree of the Disease is advanced, the Bites become proportionably more dangerous. From what I have just mentioned here it may be discerned, why, of many who have been bitten by the same Sufferer, some have been infected with this dreadful Disease, and others not.

Sec. 193. A great Number of Remedies have been highly cried up, as famous in the Cure of this Disease; and, in Swisserland particularly, the Root of the Eglantine or wild Rose, gathered at some particular times, under the favorable Aspects of the Moon, and dried with some extraordinary Precautions. There is also the Powder of Palmarius of calcined Egg Shells, that of the Lichen terrestris, or Ground Liverwort, with one third Part of Pepper, a Remedy long celebrated in England; Powder of Oyster-Shells; of Vervain; bathing in Salt Water; St. Hubert's Key, &c. &c. But the Death of a Multitude of those who have been bitten, notwithstanding their taking the greatest Part of all these boasted Antidotes; and the Certainty of no one's escaping, who had been attacked with the high raging Symptom, the Hydrophobia, have demonstrated the Inefficacy of them all, to all Europe. It is incontestable that to the Year 1730, not a single Patient escaped, in whom the Disease was indisputably manifest; and that every Medicine then employed against it was useless. When Medicines had been given before the great Symptom appeared, in some of those who took them, it afterwards appeared, in others not. The same different Events occurred also to others who were bitten, and who took not the least Medicine; so that upon the whole, before that Date, no Medicine seemed to be of any Consequence. Since that Time, we have had the Happiness to be informed of a certain Remedy, which is Mercury, joined to a few others.

Sec. 194. In short there is a Necessity for destroying or expelling the Poison itself, which Mercury effects, and is consequently the Counter-poison of it. That poison produces a general Irritation of the Nerves; this is to be removed or asswaged by Antispasmodics: so that in Mercury, or Quicksilver, joined to Antispasmodics, consists the whole that is indicated in the Cure of this Disease. There really have been many Instances of Persons cured by these Medicines, in whom the Distemper had been manifest in its Rage and Violence; and as many as have unfortunately received the Cause of it in a Bite, should be firmly persuaded, that in taking these Medicines, and using all other proper Precautions, they shall be entirely secured from all its ill Consequences. Those also in whom the Rage and Fury of this Distemper is manifest, ought to use the same Medicines, with entire Hope and Confidence, which may justly be founded on the many Cures effected by them. It is acknowledged however, that they have proved ineffectual in a few Cases; but what Disease is there, which does not sometimes prove incurable?

This Advice is truly prudent and judicious; Hope, as I have observed on a different Occasion, being a powerful, though impalpable, Cordial: and in such perilous Situations, we should excite the most agreeable Expectations we possibly can in the Patient; that Nature, being undepressed by any desponding melancholy ones, may exert her Functions the more firmly, and co-operate effectually with the Medicines, against her internal Enemy. K.

Sec. 195. The very Moment after receiving the Bite, is it happens to be in the Flesh, and if it can safely be effected, all the Part affected should be cut away. The Ancients directed it to be cauterized, or burnt with a red hot Iron (meer Scarification being of very little Effect) and this Method would very probably prove effectual. It requires more Resolution, however, than every Patient is endued with. The Wound should be washed and cleansed a considerable Time with warm Water, with a little Sea-Salt dissolved in it. After this into the Lips and Edges of the Wound, and into the Surface of the Part all about it, should be rubbed a Quarter of an Ounce of the Ointment No. 28; and the Wound should be dressed twice daily, with the soft lenient Ointment No. 29, to promote Suppuration; but that of No. 28 is to be used only once a Day.

I knew a brave worthy Gentleman abroad, who above forty Years past thus preserved his Life, after receiving the Bite of a large Rattle-Snake, by resolutely cutting it and the Flesh surrounding it out, with a sharp pointed Penknife.--Perhaps those who would not suffer the Application of the actual Cautery, that is, of a red hot Iron (which certainly promises well for a Cure) might be persuaded to admit of a potential Cautery, where the Bite was inflicted on a fleshy Part. Though even this is far from being unpainful, yet the Pain coming on more gradually, is less terrifying and horrid. And when it had been applied quickly after, and upon the Bite, and kept on for 3 or 4 Hours, the Discharge, after cutting the Eschar, would sooner ensue, and in more Abundance, than that from the actual Cautery; the only Preference of which seems to consist in its being capable perhaps of absorbing, or otherwise consuming, all the poisonous Saliva at once. This Issue should be dressed afterwards according to our Author's Direction; and in the gradual healing of the Ulcer, it may be properly deterged by adding a little Praecipitate to the Digestive. Neither would this interfere with the Exhibition of the Tonquin Powder No. 30, nor the antispasmodic Bolus No. 31, if they should be judged necessary. And these perhaps might prove the most certain Means of preventing the mortal Effects of this singular animal Poison, which it is so impossible to analyze, and so extremely difficult to form any material Idea of; but which is not the Case of some other Poisons. K.

In point of Regimen, the Quantity of Nourishment should be less than usual, particularly in the Article of Flesh: he should abstain from Wine, spirituous Liquors, all Sorts of Spices and hot inflaming Food. He should drink only Barley-Water, or an Infusion of the Flowers of the Lime-tree. He should be guarded against Costiveness by a soft relaxing Diet, or by Glysters, and bathe his Legs once a Day in warm Water. Every third Day one Dose of the Medicine No. 30 should be taken; which is compounded of Mercury, that counterworks the Poison, and of Musk which prevents the Spasms, or convulsive Motions. I confess at the same Time that I have less Dependance on the Mercury given in this Form, and think the rubbing in of its Ointment considerably more efficacious, which I should hope may always prevent the Fatality of this dreadful, surprizing Disease.

It seems not amiss to try the Effects of a solely vegetable Diet (and that perhaps consisting more of the acescent than alcalescent Herbs and Roots) in this Disease, commencing immediately from the Bite of a known mad Dog. These carnivorous Animals, who naturally reject all vegetable Food, are the only primary Harbingers or Breeders of it; though they are capable of transmitting it by a Bite to graminivorous and granivorous ones. The Virtue of Vinegar in this Disease, said to have been accidentally discovered on the Continent, seems not to have been hitherto experienced amongst us; yet in Case of such a morbid Accident it may require a Tryal; tho' not so far, as to occasion the Omission of more certainly experienced Remedies, with some of which it might be improper. K.

The great Usefulness of mercurial Frictions, we may even say, the certain Security which they procure for the Patients, in these Cases, provided they are applied very soon after the Bite, have been demonstrated by their Success in Provence, at Lyons, at Montpellier, at Pondacherry, and in many other Places. Neither have these happy Events been invalidated by any Observations or Instances to the contrary. It cannot therefore be too strongly inculcated to those who have been bitten by venomous Animals, to comply with the Use of them. They ought to be used in such a Quantity, and after such a Manner, as to excite a moderate Salivation, for fifteen, twenty, or even thirty Days. E. L. Though this Practice may justly be pursued from great Caution, when no Cautery had been speedily applied to, and no such Discharge had been obtained from, the bitten Part; yet wherever it had, this long and depressing Salivation, I conceive, would be very seldom necessary; and might be hurtful to weak Constitutions. K.

Sec. 196. If the raging Symptom, the Dread of Water, has already appeared, and the Patient is strong, and abounds with Blood, he should, 1, be bled to a considerable Quantity, and this may be repeated twice, thrice, or even a fourth Time, if Circumstances require it.

2, The Patient should be put, if possible, into a warm Bath; and this should be used twice daily.

3, He should every Day receive two, or even three of the emollient Glysters No. 5.

4, The Wound and the Parts adjoining to it should be rubbed with the Ointment No. 28, twice a Day.

5, The whole Limb which contains the Wound should be rubbed with Oil, and be wrapped up in an oily Flanel.