be a sufficient answer to this question to mention, that the duke of
Portland's powder, which is composed of bitter ingredients, excited a
fatal gout in many people who used it for that purpose. I should as soon
expect to see gold produced by the operations of fire upon copper or
lead, as expect to see the gout prevented or cured by any medicine that
acted upon the system, without the aid of more or less of the remedies
that have been mentioned.
II. We come now, in the last place, to mention the remedies which are
proper to prevent a return of that state of gout which is attended with
a _feeble_ morbid action in the blood-vessels and viscera.
This state of gout generally occurs in the evening of life, and in
persons of delicate habits, or in such as have had their constitutions
worn down by repeated attacks of the disease.
The remedies to prevent it are,
1. A _gently stimulating diet_, consisting of animal food well
cooked, with sound old Madeira or sherry wine, or weak spirit and
water. Salted, and even smoked meat may be taken, in this state of the
system, with advantage. It is an agreeable tonic, and is less disposed
to create plethora than fresh meat. Pickles and vinegar should seldom
be tasted. They dispose to gouty spasms in the stomach and bowels.
Long intervals between meals should be carefully avoided. The stomach,
when overstretched or empty, is always alike predisposed to disease.
There are cases in which the evils of inanition in the stomach will be
prevented, by a gouty patient eating in the middle of the night.
2. The use of _chalybeate medicines_. These are more safe when used
habitually, than bitters. I have long been in the practice of giving
the different preparations of iron in large doses, in chronic diseases,
and in that state of debility which disposes to them. A lady of a weak
constitution informed Dr. Cheyne, that she once asked Dr. Sydenham how
long she might safely take steel. His answer was, that "she might take
it for thirty years, and then begin again if she continued ill[72]."
[72] Essay on the Nature, and True Method of Treating the Gout, p. 69.
Water impregnated with iron, either by nature or art, may be taken
instead of the solid forms of the metal. It will be more useful if it be
drunken in a place where patients will have the benefit of country air.
3. The habitual use of the _volatile tincture of gum guiacum_, and
of other cordial and gently stimulating medicines. A clove of garlic
taken once or twice a day, has been found useful in debilitated habits
predisposed to the gout. It possesses a wonderful power in bringing
latent excitement into action. It moreover acts agreeably upon the
nervous system.
Mr. Small found great benefit from breakfasting upon a tea made of half
a drachm of ginger cut into small slices, in preventing occasional
attacks of the gout in his stomach. Sir Joseph Banks was much relieved
by a diet of milk, with ginger boiled in it. The root of the sassafras
of our country might probably be used with advantage for the same
purpose. Aurelian speaks of certain remedies for the gout which he
calls "annalia[73]." The above medicines belong to this class. To be
effectual, they should be persisted in, not for one year only, but for
many years.
[73] Morborum Chronicorum. Lib. v. Cap. 2.
4._ Warmth_, uniformly applied, by means of suitable dresses, and
sitting rooms, to every part of the body.
5. The _warm bath_ in winter, and the _temperate_, or _cold bath_ in
summer.
6. _Exercise._ This may be in a carriage, or on horseback. The viscera
being debilitated in this state of predisposition to the gout, are
strengthened in a peculiar manner by the gentle motion of a horse. Where
this or other modes of passive exercise cannot be had, frictions to the
limbs and body should be used every day.
7. _Costiveness_ should be avoided by taking occasionally one or two
table spoons full of Dr. Warner's purging tincture prepared by infusing
rhubarb, orange peel, and caraway seeds, of each an ounce, for three
days in a quart of Madeira, or any other white wine. If this medicine be
ineffectual for opening the bowels, rhubarb may be taken in the manner
formerly mentioned.
8. The understanding and passions should be constantly employed in
agreeable studies and pursuits. Fatigue of mind and body should be
carefully avoided.
9. A warm climate often protracts life in persons subject to this state
of gout. The citizens of Rome who had worn down their constitutions by
intemperance, added many years to their lives, by migrating to Naples,
and enjoying there, in a warmer sun, the pure air of the Mediterranean,
and sir William Temple says the Portuguese obtain the same benefit by
transporting themselves to the Brazils, after medicine and diet cease to
impart vigour to their constitutions in their native country.
Thus have I enumerated the principal remedies for curing and preventing
the gout. Most of them are to be met with in books of medicine, but
they have been administered by physicians, or taken by patients with so
little regard to the different states of the system, that they have in
many instances done more harm than good. Solomon places all wisdom, in
the management of human affairs, in finding out the proper times for
performing certain actions. Skill in medicine, consists in an eminent
degree in timing remedies. There is a time to bleed, and a time to
withhold the lancet. There is a time to give physic, and a time to trust
to the operations of nature. There is a time to eat meat, and there is
a time to abstain from it. There is a time to give tonic medicines, and
a time to refrain from them. In a word, the cure of the gout depends
wholly upon two things, viz. _proper_ remedies, in their proper _times_,
and _places_.
I shall take leave of this disease, by comparing it to a deep and
dreary cave in a new country, in which ferocious beasts and venomous
reptiles, with numerous ghosts and hobgoblins, are said to reside. The
neighbours point at the entrance of this cave with horror, and tell of
the many ravages that have been committed upon their domestic animals,
by the cruel tenants which inhabit it. At length a school-boy, careless
of his safety, ventures to enter this subterraneous cavern, when! to
his great delight, he finds nothing in it but the same kind of stones
and water he left behind him upon the surface of the earth. In like
manner, I have found no other principles necessary to explain the cause
of the gout, and no other remedies necessary to cure it, than such as
are admitted in explaining the causes, and in prescribing for the most
simple and common diseases.
OBSERVATIONS
UPON
THE NATURE AND CURE
OF THE
_HYDROPHOBIA_.
In entering upon the consideration of this formidable disease, I feel
myself under an involuntary impression, somewhat like that which was
produced by the order the king of Syria gave to his captains when he
was conducting them to battle: "Fight not with small or great, save
only with the king of Israel[74]." In whatever light we contemplate the
hydrophobia, it may be considered as pre-eminent in power and mortality,
over all other diseases.
[74] II. Chron. xviii. 30.
It is now many years since the distress and horror excited by it,
both in patients and their friends, led me with great solicitude to
investigate its nature. I have at length satisfied myself with a theory
of it, which, I hope, will lead to a rational and successful mode of
treating it.
For a history of the symptoms of the disease, and many interesting
facts connected with it, I beg leave to refer the reader to Dr. Mease's
learned and ingenious inaugural dissertation, published in the year 1792.
The remote and exciting causes of the hydrophobia are as follow:
1. The bite of a rabid animal. Wolves, foxes, cats, as well as dogs,
impart the disease. It has been said that blood must be drawn in order
to produce it, but I have heard of a case in Lancaster county, in
Pennsylvania, in which a severe contusion, by the teeth of the rabid
animal, without the effusion of a drop of red blood, excited the
disease. Happily for mankind, it cannot be communicated by blood, or
saliva falling upon sound parts of the body. In Maryland, the negroes
eat with safety the flesh of hogs that have perished from the bite of
mad dogs; and I have heard of the milk of a cow, at Chestertown, in
the same state, having been used without any inconvenience by a whole
family, on the very day in which she was affected by this disease, and
which killed her in a few hours. Dr. Baumgarten confirms these facts by
saying, that "the flesh and milk of rabid animals have been eaten with
perfect impunity[75]."
[75] Medical Commentaries, Philadelphia edition, vol. 7. p. 409.
In the following observations I shall confine myself chiefly to the
treatment of the hydrophobia which arises from the bite of a rabid
animal, but I shall add in this place a short account of all its other
causes.
2. Cold night air. Dr. Arthaud, late president of the society of
Philadelphians in St. Domingo, has published several cases in which it
was produced in negroes by sleeping all night in the open air.
3. A wound in a tendinous part.
4. Putrid and impure animal food.
5. Worms.
6. Eating beech nuts.
7. Great thirst.
8. Exposure to intense heat.
9. Drinking cold water when the body was very much heated.
10. A fall.
11. Fear.
12. Hysteria.
13. Epilepsy.
14. Tetanus.
15. Hydrocephalus. Of the presence of hydrophobia in the hydrocephalic
state of fever, there have been several instances in Philadelphia.
16. An inflammation of the stomach.
17. The dysentery.
18. The typhus fever. Dr. Trotter mentions the hydrophobia as a symptom
which frequently occurred in the typhus state of fever in the British
navy[76].
[76] Medicina Nautica, p. 301.
19. It is taken notice of likewise in a putrid fever by Dr. Coste[77];
and Dr. Griffitts observed it in a high degree in a young lady who died
of the yellow fever, in 1793.
[77] Medical Commentaries, Dobson's edition, vol. II. p. 476.
20. The bite of an angry, but not a diseased animal.
21. An involuntary association of ideas.
Cases of spontaneous hydrophobia from all the above causes are to be met
with in practical writers, and of most of them in M. Audry's learned
work, entitled, "Recherches sur la Rage."
The dread of water, from which this disease derives its name, has five
distinct grades. 1. It cannot be drunken. 2. It cannot be touched. 3.
The sound of it pouring from one vessel to another, 4. the sight of
it, and 5. even the naming of it, cannot be borne, without exciting
convulsions. But this symptom is not a universal one. Dr. Mead mentions
three cases in which there was no dread of water, in persons who
received the disease from the bite of a rabid animal. It is unfortunate
for this disease, as well as many others, that a single symptom should
impose names upon them. In the present instance it has done great harm,
by fixing the attention of physicians so exclusively upon the dread of
water which occurs in it, that they have in a great measure overlooked
every other circumstance which belongs to the disease. The theory of
the hydrophobia, which an examination of its causes, symptoms, and
accidental cures, with all the industry I was capable of, has led me to
adopt, is, that it is a _malignant state of fever_. My reasons for this
opinion are as follow:
1. The disease in all rabid animals is a fever. This is obvious in dogs
who are most subject to it. It is induced in them by the usual causes
of fever, such as scanty or putrid aliment[78], extreme cold, and the
sudden action of heat upon their bodies. Proofs of its being derived
from each of the above causes are to be met with in most of the authors
who have written upon it. The animal matters which are rendered morbid
by the action of the above causes upon them, are determined to the
saliva, in which a change seems to be induced, similar to that which
takes place in the perspirable matter of the human species from the
operation of similar causes upon it. This matter, it is well known, is
the remote cause of the jail fever. No wonder the saliva of a dog should
produce a disease of the same kind, after being vitiated by the same
causes, and thereby disposed to produce the same effects.
[78] "Animal food, in a state of putridity, is amongst the most
frequent causes of canine madness."
"Canine madness chiefly arises from the excessive number of
ill-kept and ill-fed dogs."
YOUNG'S ANNUALS, vol. XVII. p. 561.
2. The disease called canine madness, prevails occasionally among
dogs at those times in which malignant fevers are epidemic. This will
not surprise those persons who have been accustomed to observe the
prevalence of the influenza and bilious fevers among other domestic
animals at a time when they are epidemic among the human species.
3. Dogs, when they are said to be mad, exhibit the usual symptoms of
fever, such as a want of appetite, great heat, a dull, fierce, red, or
watery eye, indisposition to motion, sleepiness, delirium, and madness.
The symptom of madness is far from being universal, and hence many dogs
are diseased and die with this malignant fever, that are inoffensive,
and instead of biting, continue to fawn upon their masters. Nor is the
disposition of the fever to communicate itself by infection universal
among dogs any more than the same fever in the human species, and this I
suppose to be one reason why many people are bitten by what are called
mad dogs, who never suffer any inconvenience from it.
4. A dissection of a dog, by Dr. Cooper, that died with this fever,
exhibited all the usual marks of inflammation and effusion which take
place in common malignant fevers. I shall in another place mention a
fifth argument in favour of the disease in dogs being a malignant fever,
from the efficacy of one of the most powerful remedies in that state of
fever, having cured it in two instances.
II. The disease produced in the human species by the bite of a rabid
animal, is a _malignant_ fever. This appears first from its symptoms.
These, as recorded by Aurelian, Mead, Fothergill, Plummer, Arnold,
Baumgarten, and Morgagni, are chills, great heat, thirst, nausea, a
burning sensation in the stomach, vomiting, costiveness; a small,
quick, tense, irregular, intermitting, natural, or slow pulse; a cool
skin, great sensibility to cold air, partial cold and clammy sweats on
the hands, or sweats accompanied with a warm skin diffused all over
the body, difficulty of breathing, sighing, restlessness, hiccup,
giddiness, head-ach, delirium, coma, false vision, dilatation of the
pupils, dulness of sight, blindness, glandular swellings, heat of urine,
priapism, palpitation of the heart, and convulsions. I know that there
are cases of hydrophobia upon record, in which there is said to be a
total absence of fever. The same thing has been said of the plague.
In both cases the supposed absence of fever is the effect of stimulus
acting upon the blood-vessels with so much force as to suspend morbid
action in them. By abstracting a part of this stimulus, a fever is
excited, which soon discovers itself in the pulse and on the skin, and
frequently in pains in every part of the body. The dread of water,
and the great sensibility of the system to cold air, are said to give
a specific character to the hydrophobia; but the former symptom, it
has been often seen, occurs in diseases from other causes, and the
latter has been frequently observed in the yellow fever. It is no more
extraordinary that a fever excited by the bite of a rabid animal should
excite a dread of water, than that fevers from other causes should
produce aversion from certain aliments, from light, and from sounds
of all kinds; nor is it any more a departure from the known laws of
stimulants, that the saliva of a mad dog should affect the fauces, than
that mercury should affect the salivary glands. Both stimuli appear to
act in a specific manner.
2. The hydrophobia partakes of the character of a malignant fever, in
appearing at different intervals from the time in which the infection
is received into the body. These intervals are from one day to five or
six months. The small-pox shows itself in intervals from eight to twenty
days, and the plague and yellow fever from the moment in which the
miasmata are inhaled, to nearly the same distance of time. This latitude
in the periods at which infectious and contagious matters are brought
into action in the body, must be resolved into the influence which the
season of the year, the habits of the patients, and the passion of fear
have upon them.
Where the interval between the time of being bitten, and the appearance
of a dread of water, exceeds five or six months, it is probable it may
be occasioned by a disease derived from another cause. Such a person is
predisposed in common with other people to all the diseases of which
the hydrophobia is a symptom. The recollection of the poisonous wound
he has received, and its usual consequences, is seldom absent from his
mind for months or years. A fever, or an affection of his nerves from
their most common causes, cannot fail of exciting in him apprehensions
of the disease which usually follows the accident to which he has been
exposed. His fears are then let loose upon his system, and produce in
a short time a dread of water which appears to be wholly unconnected
with the bite of a rabid animal. Similar instances of the effects of
fear upon the human body are to be met with in books of medicine. The
pains produced by fear acting upon the imagination in supposed venereal
infections, are as real and severe as they are in the worst state of
that disease.
3. Blood drawn in the hydrophobia exhibits the same appearances which
have been remarked in malignant fevers. In Mr. Bellamy, the gentleman
whose case is so minutely related by Dr. Fothergill, the blood
discovered with "slight traces of size, _serum_ remarkably _yellow_."
It was uncommonly sizy in a boy of Mr. George Oakley whom I saw, and
bled for the first time, on the fourth day of his disease, in the
beginning of the year 1797. His pulse imparted to the fingers the same
kind of quick and tense stroke which is common in an acute inflammatory
fever. He died in convulsions the next day. He had been bitten by a mad
dog on one of his temples, three weeks before he discovered any signs
of indisposition. There are several other cases upon record, of the
blood exhibiting, in this disease, the same appearances as in common
malignant and inflammatory fevers.
4. The hydrophobia accords exactly with malignant fevers in its
duration. It generally terminates in death, according to its violence,
and the habit of the patient, in the first, second, third, fourth, or
fifth day, from the time of its attack, and with the same symptoms which
attend the last stage of malignant fevers.
5. The body, after death from the hydrophobia, putrifies with the same
rapidity that it does after death from a malignant fever in which no
depletion has been used.
6. Dissections of bodies which have died of the hydrophobia, exhibit the
same appearances which are observed in the bodies of persons who have
perished of malignant fevers. These appearances, according to Morgagni
and Tauvry[79], are marks of inflammation in the throat, [oe]sophagus,
trachea, brain, stomach, liver, and bowels. Effusions of water, and
congestions of blood in the brain, large quantities of dark-coloured
or black bile in the gall-bladder and stomach, mortifications in the
bowels and bladder, livid spots on the surface of the body, and, above
all, the arteries filled with fluid blood, and the veins nearly empty.
I am aware, that two cases of death from hydrophobia are related by Dr.
Vaughan, in which no appearance of disease was discovered by dissection
in any part of the body. Similar appearances have occasionally been met
with in persons who have died of malignant fevers. In another place I
hope to prove, that we err in placing disease in inflammation, for it
is one of its primary effects only, and hence, as was before remarked,
it does not take place in many instances in malignant fevers, until the
arteries are so far relaxed by two or three bleedings, as to be able to
relieve themselves by effusing red blood into serous vessels, and thus
to produce that error loci which I shall say hereafter is essential to
inflammation[80]. The existence of this grade of action in the arteries
may always be known by the presence of sizy blood, and by the more
obvious and common symptoms of fever.
[79] Bibliotheque Choisie de Medecine, tome XV. p. 210.
[80] In the 6th volume of the Medical Observations and Inquiries, there
is an account of a dissection of a person who had been destroyed
by taking opium. "No morbid appearance (says Mr. Whateley, the
surgeon who opened the body) was found in any part of the body,
except that the villous coat of the stomach was very slightly
inflamed." The stimulus of the opium in this case either produced
an action which transcended inflammation, or destroyed action
altogether by its immense force, by which means the more common
morbid appearances which follow disease in a dead body could not
take place.
The remedies for hydrophobia, according to the principles I have
endeavoured to establish, divide themselves naturally into two kinds.
I. Such as are proper to prevent the disease, after the infection of the
rabid animal is received into the body.
II. Such as are proper to cure it when formed.
The first remedy under the first general head is, abstracting or
destroying the virus, by cutting or burning out the wounded part, or by
long and frequent effusions of water upon it, agreeably to the advice
of Dr. Haygarth, in order to wash the saliva from it. The small-pox
has been prevented, by cutting out the part in which the puncture was
made in the arm with variolous matter. There is no reason why the same
practice should not succeed, if used in time, in the hydrophobia. Where
it has failed of success, it has probably been used after the poison has
contaminated the blood. The wound should be kept open and running for
several months. In this way a servant girl, who was bitten by the same
cat that bit Mr. Bellamy, is supposed by Dr. Fothergill to have escaped
the disease. Dr. Weston of Jamaica believes that he prevented the
disease by the same means, in two instances. Perhaps an advantage would
arise from exciting a good deal of inflammation in the wound. We observe
after inoculation, that the more inflamed the puncture becomes, and the
greater the discharge from it, the less fever and eruption follow in the
small-pox.
A second preventive is a low diet, such as has been often used with
success to mitigate the plague and yellow fever. The system, in this
case, bends beneath the stimulus of the morbid saliva, and thus obviates
or lessens its effects at a future day.
During the use of these means to prevent the disease, the utmost
care should be taken to keep up our patient's spirits, by inspiring
confidence in the remedies prescribed for him.
Mercury has been used in order to prevent the disease. There are many
well-attested cases upon record, of persons who have been salivated
after being bitten by mad animals, in whom the disease did not show
itself, but there are an equal number of cases to be met with, in which
a salivation did not prevent it. From this it would seem probable, that
the saliva did not infect in the cases in which the disease was supposed
to have been prevented by the mercury. At the time calomel was used to
prepare the body for the small-pox, a salivation was often induced by
it. The affection of the salivary glands in many instances lessened the
number of pock, but I believe in no instance prevented the eruptive
fever.
I shall say nothing here of the many other medicines which have been
used to prevent the disease. No one of them has, I believe, done any
more good, than the boasted specifics which have been used to eradicate
the gout, or to procure old age. They appear to have derived their
credit from some of the following circumstances accompanying the bite of
the animal.
1. The animal may have been angry, but not diseased with a malignant
fever such as I have described.
2. He may have been diseased, but not to such a degree as to have
rendered his saliva infectious.