Hints for the Treatment of Hydrophobia. By Dr. Marshall Hall.—
Many years ago I had the opportunity of watching the course of a case
of hydrophobia. It occurred in a little boy; and I scarcely left the
room during the eight-and-forty hours that he survived. But I need
not detail the series of symptoms which occurred, and which I have
described elsewhere, on the present occasion.
It has appeared to me that there are three modes of death in this
disease:—1. Sudden death from asphyxia. 2. Sudden death from
secondary asphyxia. 3. Sudden death (for in all the cases I think the
death is sudden and unexpected at the precise moment at which it occurs)
from nervous exhaustion.
Either of these modes of dissolution would be averted by the timely
institution of tracheotomy. Indeed, if this measure were adopted, the
frightful seizures which occur from trying to take liquids would be ob-
viated. These seizures consist in fearful attacks of laryngismus, and of
convulsions of the neck and pharynx, but chiefly of laryngismus, with
threatening of instant suffocation. These seizures would be disarmed of
their force and terror by tracheotomy.
Tracheotomy thus obviating the effects of laryngismus—1. The sudden
death from asphyxia, the immediate result of asphyxia, could not occur;
and 2. The sudden death from secondary asphyxia, the more remote re-
sult of many attacks of laryngismus, could not occur I
There remains the sudden death from exhaustion. It is a question
whether this would occur necessarily from the poison of hydrophobia.
Why should it occur necessarily from this poison ? No reason can be
given for this ; and we are not to be misled into a conclusion unsupport-
ed by facts, since, though all cases of hydrophobia have proved fatal, they
have proved fatal by a mode by which they would not occur if tracheo-
tomy were performed.
Could any measures be adopted to check the violence of the spasm,—
laryngismus and its effects being obviated,— such as the hydrocyanic
acid, and so to prevent the subsequent exhaustion ? Or could any
remedies be adopted to remove this exhaustion more directly, as wine or
cinchona ?
These hints I throw out for the consideration of my professional breth-
ren, in the hope of good.—Lancet.