Part 5

More difficult and terrifying are the Symptoms from the Bite of a _Mad Dog_, whose Venom has this also surprising in it, that the bad Effects do not appear oftentimes till the Cause of ’em is forgot; for the Wound is as easily cured as a common Bite is; but nevertheless a considerable time after, a melancholy Tragedy succeeds, sometimes sooner, sometimes later; for there are Instances of its being deferred to Two, (70) Six Months, nay, a Year, and longer, tho’ the attack is generally within Forty Days after the Wound; about that time, the Patient complains of Running Pains all over his Body, especially near the Part wounded, like unto those in a Rheumatism, grows pensive and sad, prone to Anger upon little or no Occasion, with an intermitting Pulse, Tremblings and Contractions of the Nerves, with a great inward Heat and Thirst; and yet in a few Days (when the Disease is come to its height) a Dread and Fear of Water, and any Liquor whatsoever; so that at the very sight of it he falls into dismal Convulsions and Agonies, and cannot drink the least drop; and this _Hydrophobia_, or _Aquæ Timor_, has been always accounted the surest Sign and Mark of this Poison, as distinguishing it from all others.

The Ancients have at large described these Symptoms, as _Galen_, _Dioscorides_, _Aetius_, _Ægineta_, but most particularly of all, _Cælius Aurelianus_ (71); and later Writers have given us several Instances of the _Hydrophobia_; Two Histories of it published, the one by Dr. _Lister_ (72), the other by Dr. _Howman_ (73), I shall more especially take Notice of, and refer to, as containing the most exact and large Account of any I have met with; he that desires more, may consult the several Authors cited by that diligent Observer, _Stalpart van der Wiel_ (74).

That this Disease is accompany’d with a _Delirium_, is almost the common Opinion both of Ancients and Moderns; _Damocrates_ called it the barking Phrensie (75); but Dr. _Lister_ agrees in this Point with _Petrus Salius Diversus_ (76), and will not allow a _Delirium_ to be the necessary consequent of this Venom; and yet at the same time he tells us, that his Patient barked like a Dog, and bit at the By-standers; that he threw into his Mouth what was given him more hastily and suddenly than it is Natural or Customary for Men to do.

From such Actions as these, together with those mentioned before in relating the Symptoms, it is obvious enough to conclude, that Persons thus affected are in a proper Sence _Delirous_. Tho’ at the same time I do think that the _Hydrophobia_ it self (whatever is commonly believed) does not at all proceed from this _Delirium_, as will by and by appear.

I know indeed that the main and plausible _Objection_ against a _Delirium_ is this, that the Patient himself does Reason against his Timorousness, tho’ he cannot overcome it, forewarns the Standers-by of his Outrageous Fits, desires them to take care of themselves, and the like. Which from what I have already said concerning a _Delirium_, appears to be very consistent with it, nay, convinces that there is the greatest Degree of it in this Case; in as much as that it is not a Distemper of the Mind but of the Body. And to this purpose I remember to have seen my self an Instance of one in a Fever, who foretold some time before any signs of a _Delirium_ were discovered, how raving and unruly He should be, and made good his _Prognostick_ to that degree, that it was very hard Work to tame and master him; tho’, as he told me afterwards, he reason’d as much as he could against that groundless Jealousie of his Friends designing to Murder him, which put him upon his Mad Actions, but was not able to Conquer the prevailing _Species_ of Fear and Anger.

This _Delirium_ therefore, as _Cælius Aurelianus_ (77) says, _Proceeds intirely from an indisposition of the Body_, which is without all doubt owing to the alteration made in the Blood by the _Saliva_ of the _Mad Dog_, instill’d into the Wound inflicted by the Bite.

That we may rightly understand this, we must take Notice, that the _Rabies_ or Madness in a Dog is the effect of a Violent Fever; and therefore it is most common in excessive Hot Weather, tho’ sometimes intense Cold maybe the Cause of it; That no Dog in this Case ever sweats; from whence it follows, that when his Blood is in a Ferment, it cannot, as in other Creatures, discharge it self upon the surface of the Body, and therefore must of necessity throw out a great many _Saline_ and Active Particles upon those Parts, where there is the most constant and easie Secretion; and such, next to the _Miliary_ in the Skin in Us, are the _Salival_ Glands; for this reason much more Spittle is separated in a Dog when Mad, than at any other time, and that very frothy, or impregnated with Hot, Subtil Parts.

Now as we every Day observe, that what is thrown out from Liquors in a Ferment, is capable of inducing the like Motion in another Liquor of the same kind, when duly mixed with it; so we may very well suppose in the present Case, that the _Saliva_, which is it self one of the most Fermentative Juices in Nature, being turgid with Fiery, Saline Particles thrown into it out of the boiling Blood, when it comes by means of a Wound to be Incorporated with the Arterial Fluid of any One, does by Degrees raise a preternatural Effervescence in it; the Effects of which will necessarily be most felt in those Parts which being tender, are the least able to refill the distension of the Blood Vessels; such are the Stomach, and especially the Brain; and hereupon _Deliria_, with _Maniacal_, and such like Symptoms, will easily insue.

A Person thus affected may be said in a Degree to have put on the _Canine_ Nature, tho’ his Reason be all this time untouch’d and intire, may Bite, Howl, _&c._ because the _like_ violent Agitation of the Blood in Him as was in the Dog will present like _Species_, and consequently (so far as their different Natures will allow) produce like Actions; just as it has been observed, that _Sheep_ bitten by a Mad Dog, have run at the Shepherd like so many Dogs to Bite him; so much can an Alteration of the Blood and Spirits do. And as a Timorous Creature may be imboldened, so we oftentimes see Persons Courageous enough by a change made in the Blood by Evacuations, that is, by want of Force and Motion in that Fluid, made sheepish Cowards, in despight of their Reason, so long as that Defect is continued.

But the main difficulties in this matter are, the Mischief discovering it self so long after the Bite, and the _Hydrophobia_.

As to the former, we are to consider, that Fermentation being a Change made in the Cohæsion of the compounding Parts of a Fluid, it is sometimes a longer, sometimes a shorter time before this Alteration is wrought; which variety may proceed either from the different Nature and Constitution of the Ferment, or of the Liquor Fermented, and a great Number of Circumstances besides. So that this Venom may be all the while doing its Work, tho’ the change made by it may not be so considerable as to be sensibly taken Notice of till a long time after.

Nay, it may so happen, that the _Ferment_ being Weak may not raise in the Blood any remarkable Agitation at all, till some accidental Alteration in the Body unluckily gives it an additional Force. As we before observed, how much external Heat concurrs to heighten the Symptoms from the Bite of the _Tarantula_. And this probably may be the Case of Those in whom this Malignity has not appear’d till Six, or Twelve Months after the Wound.

That we may understand the Reason of the _Hydrophobia_, it is to be Remarked, that this dread of Water does not come on till the latter end of the Disease, Three or Four Days before Death; that is, not till this preternatural _Fermentation_ in the Blood is come to its Heigth; and as in the Dog, so in the Patient, a great quantity of Fermentative Particles is thrown off upon the Glands of the Mouth and Stomach, as appears by his Foaming at the Mouth, _&c_.

As also, that this _Fear_ is not from a sight _of_, or any imaginary appearance _in_ the Water, for if the Vessel be close shut, and the Patient bid to suck thro’ a Quill, as soon as he has tasted, he falls into Anguish and Convulsions, as Dr. _Lister_ observed. It is therefore highly probable, if not certain, that this surprising Symptom proceeds from the intolerable _Pain_ which any Liquor at this time taken induces, partly by hurting the inflamed Membranes of the _Fauces_ in Deglutition; partly by fermenting with these Active Particles discharged by the Blood upon the _Stomachic_ Glands, and thus twitching and irritating the Nervous Membranes; the very memory of which _grievous Sence_, after it is once felt, is so terrible, that the affected Person chuses any thing rather than to undergo it a second time.

The Effects of this _Irritation_ are manifest in the Convulsions of the Stomach, and frequent _Singultus_, with which the Patient is continually oppress’d. And we all know by how necessary a kind of _Mechanism_ we do fly from and abhor those things which have proved disagreeable to the _Animal Œconomy_, to which nothing is so contrary and repugnant as _Pain_; at the first Approaches of which, Nature Starts and Recoils, tho’ Reason be arm’d with never so much Courage and Resolution to undergo the Shock.

Nor will any Body wonder how this _Ferment_ should cause such _Torment_, who considers how often, even in _Colical_ Cases, Persons are downright distracted by excessive Pain, from a Cause not unlike to this we are treating of, that is, from a corrosive Ferment in the Bowels, rarefying the Juices there into _Flatus_, and by this means irritating and stimulating those tender Membranes into Spasmodic and Convulsive Motions.

And indeed Dr. _Lister_’s Patient told him, that the very swallowing of his own Spittle put him to such Torture in his Stomach, that Death it self was not so Terrible as the Inexpressible Agony.

It may serve both to Illustrate and Confirm this Theory, to take Notice, that not only may (according to these Principles) other Bites besides that of a _Dog_ happen to induce the like Symptoms; thus _Malpighi_ (78) relates a Story of a Mother made _Hydrophoba_ by the Bite of her _Epileptic_ Daughter; but that there are other Cases, without any Bite at all, which are attended with an _Hydrophobia_.

Thus _Schenkius_ (79), _Salmuth_ (80) and others have observ’d a _Dread of Water_, without any Suspicion of a Bite, from _Malignant Fevers_. Now in _These_ there is doubtless a Hot, Putrid _Ferment_ in the Blood; and it is no wonder if Part of it be discharged upon the Throat and Stomach, which we do evidently find in these Distempers to be more particularly affected by It, especially towards the latter End, from the _Aphthæ_, _Singultus_, and the like usual Symptoms of a fatal Malignity.

Nay, _Hippocrates_ (81) himself seems more than once to have remarked something like this Symptom in Fevers, and to call those who were thus affected Βραχυπόται, or little Drinkers; for I cannot assent to Dr. _Lister_, (tho’ _Cælius Aurelianus_ be on his side) who thinks that the Βραχυπόται are ὑδροφόβοι, from the Bite of a Mad Dog; as well for other Reasons, as because _Plutarch_ (82) assures Us, that the _Hydrophobia_ and _Elephantiasis_ were both first taken Notice of in the time of _Asclepiades_ the Physician; who liv’d in the Days of _Pompey_ the Great, many Years later than either _Hippocrates_ or _Aristotle_.

Neither is it amiss to add, that _Ioannes Faber_ (83) in the Dissection of one who dy’d at _Rome_ of the Bite of a Mad Dog, and a _Hydrophobia_ succeeding it, found the Blood _Coagulated_ in the right Ventricle of the Heart, the Lungs wonderfully _Red_ and _Tumefied_; but especially the _Throat_, _Stomach_, and _Bowels_, bearing the Marks of the Inflammatory Venom.

The same Observation has been made by others in Bodies Dead of this Disease. Thus the _Acta Medica Hafniensia_ (84) relate one Case, in which, part of the Liver was _Inflamed_, the Lungs Parched and Dry, and the inner Coat of the _Stomach_ so _Mortified_, that it might be abraded with one’s Fingers.

_Bonetus_ (85) tells _another_, where all the _Viscera_ were found quite _arid_, without any Juice at all.

And in a very particular History of an _Hydrophobia_, lately published at _Ulm_, (86) We are informed, that the _Stomach_, when opened, discover’d the Marks of an _Erosion_ or Excoriation, with something like a Gangrene, and Suffusion of Blood here and there. Which does very well agree with the Observations in the _German Ephemerides_ (87), where we find several _Footsteps_ of a _Sphacelus_ or Mortification in the Bodies of Those who died _Hydrophobi_.

The Cure of this Poison is either immediately upon the Wound made, or some Days after, before the Fear of Water is discover’d; for at that time all Authors do agree the Malady to be Incurable; and the Reason is plain from what has been already deliver’d.

As in other Venomous Bites, so in this, _Galen_ (88) very wisely advises to inlarge the Wound, by making a round Incision about it, to Cauterise it with a hot Iron, and apply drawing Medicines, so as to keep it a running Ulcer at least Forty Days. (89) _Scarifying_ and _Cupping_ may answer where this Severity is not allow’d: And however, the Dressing it with _Unguentum Ægyptiacum_ (or the like) Scalding Hot, must not be omitted; by which alone, timely applied, I am assured that one Bitten was happily preserved.

But where these Means of destroying the Ferment in the beginning are omitted, the dangerous Consequences of its being mixed with the Blood is by all possible Care to be prevented.

To this purpose, to say nothing of the many Inconsiderate Jumbles of _Antidotes_, _Theriacas_, &c. nor of such vulgar Trifles as the _Liver_ of the Mad Dog, of which _Galen_ (90) observed, that tho’ some who made use of it, together with other good Medicines, recover’d, yet that they who trusted to it alone died; one of the greatest Remedies commended to us by Antiquity, is the _Cineres Cancrorum Fluviatilium_; which _Galen_ (91) says, no Body ever made use of, and miscarried; and before Him _Dioscorides_ (92) assured, that ’tis a Medicine may be rely’d on. These were given in large Quantities, _viz._ a good Spoonful or Two every Day for Forty Days together, either alone, or rather mix’d with the Powder of _Gentian Root_ and _Frankincense_. The _Vehicle_ was either Water or Wine. In like manner at this Day the Remedy in the greatest Repute of any against most Poisons in the _West-Indies_, is a kind of a _River-Craw-Fish_, call’d _Aratu_ (93).

This is manifestly an _Absorbent_, and very _Diuretic_ Medicine, especially when prepared after the right manner, which was by Burning the Craw-Fish alive upon a _Copper-Plate_, with a Fire made of the Cuttings or Twigs of _White Briony_: For whether the latter part of the Management signifies much or no, the former most certainly does; and the _Salt_ of the _Copper_, which powerfully provokes Urine, being mix’d with that of the _Ashes_, may very much exalt their Virtue.

And it is upon this same Score, that the _Spongia_ of the _Cynnorrhodos_ or _Rosa Sylvestris_ is so Celebrated an Antidote, not only for this Poison, but also for that of the Viper, _Tarantula_, and others too, that ’tis call’d in _Sicily Sanatodos_, or All-heal; this being not a _Vegetable_, as _P. Boccone_ (94) who has wrote a whole Letter of its wondrous Virtues, terms it, but an _Animal Alkali_, as well as the former; for as Mr. _Ray_ (95) has observed, this Spongy Excrescence, if it be cut, is found full of White Worms; Being the Nest of these Insects, which lodging here all the Winter, do in the beginning of the Spring turn to Flies, and quit their Quarters. Indeed this Remedy was antiently too of so great Esteem, that _Pliny_ recommends it as the only Cure of an _Hydrophobia_, divinely discovered by an Oracle (96).

As all Insects abound with a Diuretick Salt, so _Cantharides_ more than any others; therefore the Learned _Bacchius_ (97) goes farther, and from the Authority of _Rhazes_ and _Joannes Damascenus_, advises to give these in Substance for many Days together. The Preparation of this Antidote, (so he calls it) is by infusing the _Cantharides_ in Soure Butter-milk Twenty Four Hours, then drying them, and with the Flower of Lentils and Wine making them up into _Troches_ of a Scruple Weight, of which one is to be taken every Day, By which means he assures us, that tho’ the Patient make bloody Urine, yet that Milk largely drank will abate that Symptom, and that an _Hydrophobia_ will be happily prevented. _Boccone_ (98) tells Us, That in _Upper Hungary_ They give _Cantharides_ to Men bitten by a Mad Dog, _Five_ to a Dose; and to _Beasts_ in greater Quantity. But of the inward Use of these Flies more in its proper Place.

In short, all the _Specifics_ in this Case are such as do either absorb a peccant _Acidity_ in the Stomach, or carry it off by Urine; as _Terra Lemnia_, highly commended by _Galen_ (99), _Garlick_, _Agrimony_, _Oxylapathum_, and many others, of which a Catalogue may be seen in _S. Ardoynus_. So the _Alyssum_ or Madwort, celebrated for this use by the Ancient Physicians, as well _that_ described by _Diascorides_, which is a Species of _Leucoium_, as the other of _Galen_, which is a _Marrubium_, is very manifestly a Bitter, Stomachic, and Diuretic Plant (100). The _Lichen cinereus terrestris_, recommended in the Philosophical Transactions (101), Operates the same way.

But the greatest and surest Cure of all, is frequent _Submerging_ or Ducking the Patient in Water. The first mention I find of this is in _Cornelius Celsus_ (102); whether he had it from the Ancient _Grecian_ Physicians, or it was the Discovery of his own Age, matters but little to our Purpose; certain it is, that he collected his Principal Rules of Bathing from _Cleophantus_, who, as _Pliny_ says (103), did, besides many other delightful things, first introduce the Use of Baths; As appears by comparing the Writings of the _One_ with the Fragments of the _Other_, preserv’d in the Works of _Galen_. And that from _Asclepiades_, who afterwards so far improved this Part of Physick, that he discarded almost all inward Medicines, he might learn this Management, is not improbable; for the _Hydrophobia_ (as we before took Notice) having been first regarded in the time of this great Physician, ’tis very likely that among other Advantages of his new Method, he might commend it for the Cure of so deplorable a Malady.

However it be, This Practice was in this last Age with great Authority revived by the Ingenious _Baron Van Helmont_ (104), who having in his own Country seen how great Service it did, has at large set down both the manner of the Operation; and, Consonant to the Principles of his own Philosophy, shewn the Reason of its good Effects. Since him _Tulpius_ (105), an Observer of very good Credit, takes notice, that tho’ he saw many, yet that never one miscarry’d, where it was in time made use of.

As all Baths do chiefly act by the sensible Qualities of Heat and Cold, and the Gravity of their Fluid; so we need go no farther to fetch the Reason of the great Advantage of this Method in the present Case, than to the Pressure of the Water upon the Body of the Patient.

Every one knows how plentifully plunging into cold Water provokes Urine, which proceeds no doubt from the constriction hereby made of the Fibres of the Skin and Vessels. Thus this outward Cure differs not much in effect from the inward Medicines beforementioned, but must necessarily have the better of them in this Respect, that when the Fermenting Blood stretches its Vessels, the exceeding weight of the ambient Fluid resists and represses this Distension, and so prevents the Effects of It. For this Reason the Salt Water of the Sea is especially chosen for this Business, because its greater Gravity than that of Fresh does more powerfully do all this, and break the beginning Cohæsion of the Parts of the Blood.

Thus we may, without having recourse to the _Fright_ and _Terror_, with which this Method, when rightly practis’d, (by keeping the Party under Water for a considerable time, till he is almost quite drowned) is usually accompanied, probably enough account for the Advantages of this Immersion. Tho’ it is not unlikely that this new Fear may have some good Effect in the Case too, for not only Convulsions, but Agues, and other Diseases, have oftentimes been happily Cured, merely by terrifying and surprising the Patient.

The Reason of this will easily be understood by him who knows what Alterations the Passions of the Mind do make in the Fluid of the Nerves and Arteries; of which in another Place.

It may for our present purpose suffice to take Notice, That as in Consideration of the last mentioned Effect upon the Mind, _Van Helmont_ commends this same Practice in all Sorts of Madness, and Chronical _Deliria_; so upon the account of the before hinted Alterations on the Body, Bathing was, among the Ancients, the common Cure of Melancholy, and such like Distempers (106). And as the younger _Van Helmont_ (107) to confirm his Father’s Notions, tells Us, that one Dr. _Richardson_ did with wonderful Success make use of this Management in these Cases, so in like manner _Prosper Alpinus_ (108) takes Notice, that the _Egyptians_ do at this Day perfectly recover Melancholy Persons by the same Method, only with this Difference, that they make their Baths warm.

He that compares what has been already advanc’d concerning _Deliria_, with the _Bellinian_ Theory of Melancholy and Maniacal Distempers, and reflects upon the Nature of Baths, and their manner of Acting, will see so much Reason in this Practice, as to be sorry that ’tis now-a-days almost quite laid aside and neglected. For we must observe, that altho’ there be some Difference in the Treatment and Cure of _Deliria_, whether Maniacal or Melancholy, when they are Originally from the Mind, as the Effects of Care, Trouble, or the like, and when from an Indisposition of the Body; yet that both do agree in this, that they require an Alteration to be made in the Blood and Spirits; inasmuch as the Mind, by often, nay, almost continually, renewing to it self any one _Idea_, of Love, Sorrow, _&c._ does so constantly determine the Spirits and Blood, one and the same way, that the Body does at last as much share in the Alteration, as if it had been primarily affected, and consequently must have, in some manner, the same Amendment. Upon this Score _Baccius_ (109) asserts the admirable Use of Temperate Baths, in all kind of Distractions; and assures us, that not only common _Deliria_, but even the _Dæmoniaci_, _Phanatici_, _Lycanthropi_ themselves, _&c._ are cured by frequent Washings in fresh Water, and a moist and Nourishing Diet.

But to insist upon this Subject is foreign to our purpose; only in regard that the most usual Methods of Cure in these Cases are so very tedious, and oftentimes unsuccessful at the last, I thought it not amiss to hint thus much, in order to the advancing something more Certain and Effectual towards the Removal of the greatest Unhappiness to which Mankind is liable.

To conclude with the _Hydrophobia_; where these Remedies fail, or are Administred too late, the Patient, from the prevailing inflammatory Disposition of the Blood, grows more and more _Delirous_, and by Degrees downright raving Mad, at last (as it most commonly happens in Maniacal People) suffers a total Resolution of Strength, and Dies. Thus Dr. _Howna_’s Case ended in a perfect universal _Paralysis_.

FOOTNOTES to Essay II.

(48) _De Tarantul._

(49) _Histor. Animal. Nov. Hispan._ Tract 4. c. 5

(50) _Baglivi_, p. 11.

(51) _Vid. Fig. 16._

(52) _Micrograph. Curios._ p. 69.

(53) Pag. 40.

(54) Of Languid and unheeded Motion.

(55) _Borelli De Vi Percussion._ Prop. 90, _and_ 111.

(56) _De Sanitate Tuenda_, lib. 1. c. 8.